The Health Economics & Outcomes Research (HEOR) and Payer Relations Manager is responsible for developing evidence-based value propositions for Quest tests. The HEOR and Payer Relations Manager will work independently and as a member of a cross-functional team, supporting the clinical franchises and medical directors by researching, evaluating and presenting clinical evidence in support of the Quest test portfolio. In addition to clinical evidence research, this professional will be responsible to for identifying test-specific health economic opportunities.
The HEOR and Payer Relations Manager will leverage clinical and health economic evidence to influence internal and external organizations including health policy makers, reimbursement agencies, health plans, health care providers, employers and consumers to justify coverage & reimbursement and support optimal utilization of Quest products.
Deliver priority HEOR deliverables, including but not limited to, product level value assessments, evidence gap assessments, global value dossiers, economic models, etc.
Ensure that HEOR activities are prioritized through collaboration with key business leaders to ensure maximum impact of HEOR projects/resources on potential revenue/profitability.
Research and select relevant clinical and health economic studies to be included in various types of documentation in support of payer coverage and reimbursement.
Contribute substantially to, and/or manage the development of medical materials (e.g., product white papers, clinical dossiers and policy response letters to payers, health economic manuscripts and/or presentations).
Advice the clinical franchises and R&D on clinical evidence gaps, reimbursement risk and best strategies to achieve favorable coverage for tests.
Research, review and summarize payers’ policies for specific test coverage.
Develop health economic models for tests to establish value propositions and to provide justification for premium pricing.
Lead and/or substantially contribute to the communication of product value proposition to internal and external stakeholders.
Assume project management responsibilities for some aspects of the evidence-based medical documentation development and communication.
Perform other functions of the HEOR – MA department as needed.
Assist in the development of HEOR strategies aligned with business needs and the evolving external health system environment (private and government payers, regulatory environment) for optimal access, reimbursement and utilization of Quest products.
Prioritize the development of medical documentation and HEOR activities based on overall business needs.
Maintain knowledge of all Quest-relevant disease states, franchises, products, tests, changing health policy and reimbursement environment and ensure it is incorporated into the short and long-term business plans.
To qualify, the ideal candidate will have the following:
MS, MPH, Ph.D or Pharm. D in a relevant discipline (e.g., Health Policy, health economics, medicine, public health, psychometrics, and epidemiology) is preferred. Alternatively, Bachelor’s degree in a scientific or medical discipline, successful completion of a certificate program in HEOR or Comparative Effective Research, and 5 or more years’ experience in medical affairs in the diagnostic, pharmaceutical or medical device industry.
Hands-on experience with HEOR methodologies is preferred, as is a track record of successful application of HEOR data with key external stakeholders such as health policy makers, reimbursement agencies, health care providers and others, to support the business growth
Clinical laboratory experience is a strong plus.
In-depth knowledge of medical terminology.
Proficiency in medical and scientific information retrieval and comprehension of technical and medical literature.
Demonstrated ability to critically evaluate scientific publications for relevance, credibility and bias.
Demonstrated skills in medical and technical writing.
Health Technology Assessment experience a plus.
Demonstrated intermediate-advanced skills in using Microsoft™ Word, Excel, and PowerPoint software packages.
Project management skills.
Strong written and oral communication skills.
Demonstrated time management skills; ability to prioritize multiple projects; effectively work in cross-functional teams; and ability to multi-task.
Demonstrated understanding of the healthcare, health insurance, Medicare and regulatory environment.
Action-oriented, customer-focused, with effective prioritization, goal-setting and time management skills.
Effective analytical/problem solving skills, including generation of original and innovative ideas and solutions.