Might you know any manager-level medical device reimbursement strategy and Healthcare Economics & Outcomes Research (HEOR) experts who are exploring opportunities?
(We pay a MIN of a $500 referral fee for any new candidate successfully placed by our client after the qualifying period. It's a great way to create win/wins and help those you know.)
MANAGER, REIMBURSEMENT & HEALTH POLICY ?
MEDICAL DEVICE REIMBURSEMENT STRATEGY/HEOR REQUIRED) - WESTERN US OR POSSIBLE REMOTE POSITION
We have been engaged to identify a strong reimbursement manager with medical device and Healthcare Economics (HEOR) experience (vs. those with medical billing experience). This is a very niche role, and we are conducting our search nationwide. Our client is a Southern-CA-based world leader in innovation and manufacture of scientific women's health products and services.
Applicants must be fully authorized to work in the U.S. without sponsorship. Ideally, this client also seeks a relatively stable work history.
The Manager, Reimbursement & Health Policy position will be responsible for the development and execution of reimbursement strategies that enable successful adoption of the divisions medical devices through effective coding, sufficient coverage and optimal payment mechanisms. The position will work in close partnership with the health economics team to develop and communicate evidence-based value propositions to both public and private payers. Providing insights to increasingly complex dynamics of global market access across a broad range of medical devices, this individual will serve as an internal expert on healthcare reform trends, policies, payer relations, HTA (Health Technology Assessments) and global reimbursement. This position will also examine the opportunity to partner with third party payers to improve patient care and outcomes, including the development of quality-based measures. The scope of responsibility includes all aspects of market access strategy, tactics and communication.
Essential Job Functions
? Develops, implements, monitors, and defends best in class reimbursement strategies in support of all major marketed and pipeline devices
? Leads and aligns the reimbursement and health policy function to deliver on Company?s objectives
? Responsible for development and execution of coding, coverage and payment strategies
? Understands policies, educates internal management teams, and develops strategic objectives for addressing major changes in the US (Affordable Care Act) and global healthcare environment
? Collaborates with health economics team, with the ability to understand evidence generation plans, resources and toolkits that may be leveraged for reimbursement discussions/ applications
? Develops and manages effective strategies to increase/optimize reimbursement and/or market access for all devices
? Drive adoption of quality measures and clinical guidelines that can support reimbursement strategies
Medical Policy Coverage:
? Design and drive reimbursement and communication strategies to proactively research and leverage data in order communicate value to providers and payers, as well as negotiate favorable medical policies/coverage with government (CMS) and commercial payers on a regional level
? Petitions medical directors and payers for positive coverage/policy update for devices, based on new product data or new clinical studies on existing products.
? Responsibilities include maintaining and cultivating relationships with key measure entities including CMS, NCQA, IHI, NICE, WHO. PCORI, NQF, PQA, professional societies, and provider organizations.
Pipeline and Business Development
? Leverage reimbursement expertise to help assess and provide recommendations for market opportunities that are currently not within client portfolio of products
Relationships & Communication:.
? Interface with key individuals within the payer community (CEO, CFO, Medical Directors, etc.) on a national and regional level (government as well as commercial payers) and with key stakeholders in the medical community to guide implementation of focused strategies and programs.
? Develop and maintain relationships with key thought leaders within the private sector and payer communities to effectively assist client with regional and national payer strategies.
? Work with Advocacy and Managed Care department and business units as needed to effectively influence positive public policy and reimbursement decisions.
? Work cross-functionally to support projects/business needs: Sales, marketing, R&D, business development and finance.
? Create and conduct internal and external education programs around the 21st century Cures Act, Value Based purchasing programs including the MIPS Program, and the MACRA program
This position is an individual contributor role
- Management responsibilities will consist of managing projects, programs and vendors
Budgetary responsibilities will roll up to the Director of Health Economics & Reimbursement?s cost center.
Customer and Key Contacts:
Support clinical and commercial functions through proactively presenting reimbursement or policy information of value to inform internal decision-making and external communications
- Conduct field visits with sales team members to understand the business and educate teams on managed care topics/issues.
- Field travel visits:
- To defend or pursue the execution of reimbursement strategies or policies
- To assist with payer issues encompassing coverage and reimbursement.
- To establish strong relationships with KOLs for future payer efforts
- To better understand customer challenges
- To demonstrate and articulate the value of client
- Hands-on attitude, highly willing to roll up own sleeves to get activities done
- Highly organized with an ability to prioritize and deliver high quality, accurate work within the required timeline for self and others
- Able to operate with significant autonomy; self-starter
- Excellent interpersonal and communication skills, strong oral/written presentation skills including the ability to communicate complex ideas in a simple way and to tailor key messages and presentation style to multiple audiences
- Knowledge of disease states such as PAD, ESRD and Cancer is highly preferred
- Solid understanding of reimbursement fundamentals including coding, coverage and payment
- Client seeks manager-level candidate ONLY
Education and/or Experience
- Bachelor?s degreerequired
- Experienceworking with public and private payer processes for obtaining coding, coverage and payment, Medical Devices is preferred
- Product launch experience from a market access perspective
- Ability to review clinical and health economic literature in order to understand the implications for value to payers
- Strong Healthcare Economics (HEOR) expertise including medical coding including experience working with public and private payers
- Must have medical device experience
PHYSICAL DEMANDS: ~30% travel
Our client is an equal opportunity employer.
Applicants: Please send a WORD version of your resume and ideally, a few brief bullets indicating how you meet the stated requirements.