Director, Pharmacy 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 business lines.

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

• Lead the teams responsible for Network Reconciliation and MAC Pricing.

• Ensure that the contracted pharmacy rates are implemented, monitored, and achieved effectively.

• Convert network pricing strategies into tangible financial results through reconciliation, variance management, and pricing adjustments.

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

• Validate the performance of the pharmacy network against the contracted effective rates and pricing guarantees.

• Manage reconciliation outcomes and guarantee accurate financial settlements aligned with contract stipulations.

• Create processes to oversee, evaluate, and report network performance against contractual objectives.

• Identify performance discrepancies and initiate corrective measures.

• Ensure readiness for audits, financial transparency, and adherence to governance standards.

• Supervise pharmacy network performance across various pricing constructs such as effective rate, MAC, NADAC, PAC, and flat AWP pricing.

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

• Monitor claim-level reimbursement performance to identify outliers and pricing inefficiencies.

• Promptly drive MAC adjustments to address performance gaps, market changes, and provider behaviors.

• Establish governance and controls for competitive and compliant MAC pricing in alignment with enterprise financial objectives.

⛳️ Requirements

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

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

• At least 3 years of leadership experience demonstrating the ability to cultivate high-performing teams and achieve measurable results in a professional services setting is required.

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

• Experience with RFP pricing and competitive market analysis is required.

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

• Participate in, adhere to, and support the objectives of the compliance program.

• Ability to consistently engage cooperatively and respectfully with colleagues.

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

🏝️ Benefits

• Comprehensive 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 up to 5% with no vesting requirement.

• Adoption Assistance Program.

• Flexible Spending Account.

• Educational Assistance Plan and Professional Membership support.

• Referral Bonus Program – earn up to $750!

• STAR Bonus: a maximum at-risk bonus of 15.00%.