Director, PBM Network Pricing – Market Planning

This is a fully remote position, open to applicants in United States.

📋 Description

• Take ownership of the financial performance of the pharmacy network across all service lines.

• Meet contracted reimbursement guarantees, ensuring effective rate (BER/GER) performance and MAC pricing results.

• Direct the Network Reconciliation and MAC Pricing teams.

• Assess pharmacy network performance against the agreed effective rates and pricing guarantees.

• Manage reconciliation results, financial settlements, and adherence to contract terms.

• Establish and implement processes to monitor, measure, and report on network performance in relation to contractual objectives.

• Identify performance discrepancies and initiate corrective measures with the Network Contracting and Pricing teams.

• Ensure readiness for audits, maintain financial transparency, and uphold governance in reconciliation processes.

• Supervise pharmacy network performance across effective rate, MAC, NADAC, PAC, and flat AWP pricing structures.

• Lead the development, maintenance, and performance evaluation of enterprise MAC pricing.

• Track claim-level reimbursement performance for anomalies and pricing inefficiencies.

• Propel MAC adjustments to address performance deficits, market fluctuations, and provider behavior.

• Collaborate with leadership from Network Contracting, Underwriting, Finance, and Analytics.

⛳️ Requirements

• A Bachelor’s degree in Business, Finance, Economics, Healthcare Administration, or a related field, or equivalent professional experience is required.

• A minimum of 7 years of progressive experience in PBM, healthcare plans, pharmacy networks, or a related area is required.

• At least 3 years of leadership experience with a proven track record of building high-performing teams and achieving measurable outcomes in a professional services context is required.

• Proven experience in pricing strategy, market analysis, or network planning is required.

• Experience in supporting RFP pricing and conducting competitive market analysis is required.

• Prior experience in a leadership role or matrix-management setting is preferred.

• Commitment to participating in, adhering to, and supporting compliance program objectives.

• A consistent ability to interact cooperatively and respectfully with colleagues.

• Remote work is not available to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

🏝️ Benefits

• Competitive benefits package for Health, Dental, and Vision insurance.

• 20 days of paid time off.

• 4 weeks of paid parental leave.

• 9 paid holidays.

• 401K company match of up to 5% with no vesting requirement.

• Adoption Assistance Program.

• Flexible Spending Account.

• Educational Assistance Plan and support for Professional Memberships.

• Referral Bonus Program – up to $750.