Director, Government Pricing

Role Overview

Medispend's government pricing business is growing, and this is the senior addition that allows it to scale. The Director, Government Pricing is accountable for the accuracy, compliance, and timeliness of government pricing, Medicare, and VA/federal program deliverables across our client portfolio — and for building the capability of the team that produces them.

This is a hands-on role. You will personally perform the most complex calculations and historical corrections, approve client-ready output, and make the regulatory determinations behind both. You will hold approval authority alongside the Senior Director, and extending that depth across the team is a priority — we are targeting three qualified approvers within twelve months.

We deliver these services as a managed service to pharmaceutical manufacturers, predominantly small and mid-size companies without the scale to build government pricing depth in house, so you will be a senior client-facing figure as well as an internal leader.

Key Responsibilities:

Technical execution and regulatory authority

• Personally perform complex calculations, variance analyses, and historical corrections across AMP, Best Price, URA, PHS/340B ceiling price, ASP, NFAMP, and FCP.
• Develop and approve calculation methodologies and reasonable assumptions jointly with the Senior Director, ensuring positions are defensible, documented, and consistently applied.
• Interpret CMS Medicaid Drug Rebate Program regulations and guidance — line extension, 5i versus standard AMP treatment, brand, generic and authorized generic classification, baseline AMP, prompt pay treatment, and UPPS reporting.
• Determine transaction eligibility and treatment across AMP, Best Price, ASP, and NFAMP, including returns, chargebacks, rebates, administrative fees, bona fide service fee exclusions, and class of trade.
• Own program-level positions and approve submissions for Medicare (Part B ASP reporting and certification, Part B inflation rebate, Part D Manufacturer Discount Program) and VA/FSS (65IB, NFAMP, FCP, IFF, quarterly VA sales reporting, TRICARE).
• Lead historical recalculation and remediation engagements end to end — scope, correction methodology, liability impact, client communication, CMS change requests, and resubmission approval.
• Review bona fide service fee eligibility and fair market value support, including PBM administrative fee structures, and determine their Best Price, AMP, ASP, and NFAMP implications in partnership with Legal.
• Monitor CMS, HRSA, and VA policy developments and translate new requirements into calculation, reporting, and system changes.

Review, approval, and quality

• Review and approve client-ready deliverables across all programs in scope, applying consistent quality control standards and internal controls.
• Establish a tiered, risk-based review framework so review depth matches exposure, and maintain a documented sign-off record.
• Monitor CMS, VA, and client deadlines across the portfolio, resolve capacity constraints before they threaten a deadline, and investigate root cause whenever an error reaches a client.

Building capability

• Manage, coach, and develop Government Pricing Analysts and Team Leads — setting priorities, allocating workload, and ensuring coverage across competing deadlines.
• Develop at least one additional qualified approver from within the team inside twelve months and develop the Medicare and federal program leads to independent ownership of their programs.
• Establish and maintain a documented position log of regulatory determinations, alongside methodology documentation, SOPs, and review criteria.
• Lead technical development, performance management, succession planning, and hiring for the team.

Client partnership, commercial support, and operating performance

• Serve as a senior escalation point for complex client issues and disputed results, lead quarterly business reviews, and explain calculation outcomes and rebate liability exposure to client Finance, Legal, and Compliance stakeholders in clear business terms.
• Support Sales and Account Management with scoping, statements of work, and level-of-effort estimates, and advise clients on Medicaid inflation penalty exposure and proposed WAC increase impacts.
• Establish and monitor KPIs and service-level targets — timeliness, exception and rework rates, backlog aging, and team utilization — and manage to project budgets and account-level cost to serve.
• Build the business case for automation and partner with IT, Product, and Development on government pricing logic, configuration, and calculation testing.

Required Qualifications:

• Bachelor's degree in Finance, Accounting, Business, Economics, Healthcare Administration, or a related field; advanced degree a plus.
• 10+ years of pharmaceutical government pricing experience, the majority gained inside a manufacturer or in a role directly accountable for manufacturers' reported prices and certifications.
• Personal, hands-on ownership of AMP, Best Price, and URA methodology and calculation — not oversight alone. This role performs the work as well as directing it.
• Deep expertise in the Medicaid Drug Rebate Program, PHS/340B ceiling price, and federal pricing requirements, sufficient to review and approve any calculation the team produces.
• A record of establishing, documenting, and defending reasonable assumptions and regulatory positions that withstood audit or client scrutiny, including multi-period historical recalculations and corrected CMS submissions.
• Working knowledge of Medicare Part B ASP reporting and certification, the Part D Manufacturer Discount Program, and VA FSS 65IB contracting, NFAMP, FCP, and IFF obligations.
• 3+ years leading analysts or technical staff, with a demonstrated record of raising people's technical capability — not only managing workload.
• Experience with government pricing platforms such as iContracts, Model N, IntegriChain, EVERSANA, Vistex, or comparable solutions, and advanced Excel skills.
• Ability to manage competing priorities in a deadline-driven environment, with an uncompromising commitment to accuracy and compliance.

Preferred Qualifications:

• Managed services, consulting, or outsourced provider experience supporting multiple pharmaceutical manufacturers.
• Experience in a smaller or scaling organization where process, documentation, and controls had to be built rather than inherited.
• Experience building a methodology or regulatory position library used by a team, and establishing KPIs, service-level targets, and quality metrics.
• Experience advising on line extension, 5i treatment, authorized generic relationships, class of trade, and UPPS corrections.
• Working knowledge of Public Law pricing compliance and Trade Agreements Act (TAA) requirements.
• Experience applying AI or automation tooling to regulatory research or calculation workflows, and working proficiency with SQL, Power Query, Alteryx, or comparable data tooling.

What we provide:

• Merit-based compensation – Competitive base salary plus bonus
• Work from anywhere – Roles are open to candidates located anywhere in the US (United States)
• Paid Parental Leave
• Health and wellness perks including life & disability insurance, healthcare funding options like FSAs (Flexible Spending Accounts) and HSAs (Health Savings Account), Dependent Care, an EAP (Employee Assistance Program) program, discounts, Learning and Development

Working Conditions/Physical Demands:

This position is fully remote, with limited travel that may be required for occasional team meetings, training sessions, or business events. Work is performed primarily in a home-office environment using standard office equipment such as a computer, keyboard, mouse, and phone. Employees are expected to maintain a safe, ergonomic, and confidential workspace with reliable high-speed internet access suitable for professional remote work.

The role generally requires extended periods of sitting, viewing a computer screen, and communicating through written and verbal means. Occasional light physical activity (e.g., lifting materials or equipment up to 20 pounds) may be necessary.

Employees working remotely must ensure their workspace meets company standards for safety, ergonomics, and data security as outlined in organizational policy.

Disclaimer: This job description identifies the general duties and minimum level of skills required to perform this job. It is not intended to represent a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned.

Notice for all applicants: we are seeking a permanent full-time employee, this is not a contractor position.

Notice for Colorado and Washington applicants: In compliance with applicable pay transparency laws, the expected annual base salary for this role is $150,000–$200,000, plus eligibility for bonus and benefits.

To all recruitment agencies: We do not accept unsolicited agency resumes and are not responsible for any fees related to unsolicited resumes.