Sr. Manager, Government Pricing

Navitus Health Solutions, LLC

2d•Remote

About The Position

Due to growth, we are adding a Sr. Manager, Government Pricing to our team. The Sr. Manager, Government Pricing is responsible for the strategic leadership, governance, and execution of Medicaid fee‑for‑service (FFS) drug pricing, reimbursement analysis, and drug economics activities. This role provides managerial oversight of analysts and senior analysts while serving as a subject matter expert (SME) in Medicaid drug pricing constructs, generic market dynamics, MAC and 340B file governance, and state‑specific regulatory initiatives. The Sr. Manager, Government Pricing plays a critical role in supporting State Medicaid agencies through accurate pricing models, predictive trend analysis, and compliant drug classification methodologies. The Sr. Manager will oversee implementation and accurate administration of state directed MAC (SMAC) pricing when applicable and is accountable for the production, delivery, validation, and integrity of Maximum Allowable Cost (MAC) and 340B files, ensuring alignment with Medicaid regulations, HRSA guidance, NADAC benchmarks, and industry pricing standards. The Sr. Manager partners cross‑functionally with IT, Regulatory, Legal, Analytics, and external vendors to ensure the integrity, transparency, and defensibility of pricing outputs used in State budgetary models, program design, and operational execution. Is this you? Find out more below!

Requirements

Bachelor’s degree in Finance, Economics, Statistics, Actuarial Science, Health Policy, or a related field, or equivalent work experience, required.
5+ years of experience in Medicaid pricing, PBM analytics, drug economics, or healthcare financial analysis required.
5+ years of experience leading, developing, and managing analytical teams, including performance management and talent development or equivalent experience required.
Demonstrated experience with Medicaid fee‑for‑service programs, drug reimbursement methodologies, and regulatory interpretation.

Responsibilities

Provide direct managerial oversight for pricing analysts supporting Medicaid fee‑for‑service programs, including performance management, coaching, and professional development.
Establish workload prioritization, quality standards, and delivery timelines aligned with State requirements and contractual obligations.
Serve as escalation point for complex pricing, classification, and regulatory interpretation issues.
Lead development and maintenance of Medicaid FFS pricing models, reimbursement methodologies, and financial risk assessments tailored to State‑specific program designs.
Collaborate with other leaders to interpret Medicaid statutes, CMS guidance, State Plan Amendments (SPAs), and program‑specific initiatives to ensure compliant pricing strategies and deliverables.
Support State budgetary planning through predictive trend analysis, including utilization shifts, generic penetration, biosimilar adoption, and market disruptions.
Provide pricing and underwriting expertise in support of State negotiations, program amendments, audits, and inquiries.
Accountable for administration and facilitation of quarterly State MAC performance reviews.
Ensure all State reporting is delivered within the format and schedule as directed by the State contract.
Act as subject matter expert for drug identification and classification, utilizing industry recognized sources, including Medi Span multisource codes, NADAC pricing benchmarks, and HRSA guidance and 340B ceiling price constructs.
Lead analysis of generic and biosimilar drug market trends, including new to market generics, supply shortages across retail and specialty channels, and the impact on market volatility on Medicaid reimbursements and access.
Oversee the end‑to‑end production, delivery, validation, and integrity of MAC, SMAC and 340B pricing files supporting Medicaid programs. Ensure ongoing reconciliation and validation.
Establish controls and review protocols to ensure pricing accuracy, audit defensibility, and alignment with regulatory and contractual requirements.
Partner with IT and Analytics to ensure data pipelines, pricing logic, and system outputs are accurate, reproducible, and documented.
Respond to State, regulatory, and audit inquiries related to MAC methodologies, 340B pricing, and drug cost transparency.
Collaborate cross‑functionally with IT, Regulatory, Legal, Analytics, Operations, and Finance to ensure aligned execution of Medicaid pricing strategies.
Serve as the primary pricing liaison with external stakeholders, including State Medicaid agencies, data vendors (e.g., pricing compendia providers), and pharmacy and program partners.
Other duties as assigned.