Principal, PBM Business and Regulatory Strategy

Navitus Health Solutions, LLC

2d•Remote

About The Position

Due to growth, we are adding headcount! Our Principal, Business and Regulatory Strategy will be the liaison between legal and our provider services team using superior knowledge of PBM regulatory requirements to align them with our payables and reimbursement strategies. The Principal, Business and Regulatory Strategy is for driving business solutions and readiness that aligns with regulatory transformation and requirements. Acting as a connective tissue between Compliance, Legal, Product, Technology, Operations, and the business unit, this role translates the interpretation of statutes from the Legal team including rules, guidance, and standards into actionable work, and facilitates durable, risk‑right solutions. The role partners closely with Legal on interpretation, drives cross‑functional implementation plans, designs and validates controls, and ensures sustainable adherence for Medicare, Medicaid/State programs, Exchange/Commercial, privacy & security, auditing/monitoring, and related accreditation obligations. Is this you? Find out more below!

Requirements

Bachelor’s degree in business, or other directly applicable field, or equivalent work experience, required.
10+ years’ experience in healthcare/health plan/PBM regulatory compliance, pharmacy operations management, regulatory operations, or operational implementation required.
Demonstrated success leading cross‑functional regulatory change.
Ability to translate regulatory text into practical requirements, contractual implications and control designs; strong partnership with Legal and technical/operational teams.
Proficiency with risks, issues, testing, and evidence advanced communication, facilitation, and influence skills across executive to front‑line levels.
Strong knowledge of pharmacy contracting and/or pharmacy benefits regulatory requirements.
Proven ability to lead cross-functional teams and influence senior stakeholders.
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees

Responsibilities

Drive cross‑functional operational requirements and implementation (scope, milestones, owners, dependencies, and success criteria) spanning Product, Operations, Technology, and Customer Success.
Coordinating complex pharmacy benefits relationships through operational and contract understanding, inter-entity dynamics, and reimbursement structures and strategies.
Facilitate solution design to reflect regulatory intent and operational practicality.
Manage traceability from requirement to control to process/tech change to evidence.
Define/validate preventive & detective controls; align with policies, standards, and procedures.
Establish accompanying fit‑for‑purpose evidence models (reports, dashboards, logs, audit trails) and/or testing protocols to demonstrate ongoing adherence to regulatory requirements.
Ensure policies, procedures, desk‑level work instructions, and training are updated prior to effective dates.
Coordinate change readiness and adoption with affected teams including recommending content relevant to client impact and experience.
Exercise authority to gate/hold releases when regulatory or control gaps create material risk, escalating through leadership as needed.
Sign‑off authority on control adequacy and evidence sufficiency for go‑live operational readiness.
Monitor reduction in post‑go‑live defects and implement root cause analysis or defect remediation plans supportive of the regulatory environment.
Other duties as assigned.