Access and Reimbursement Manager

This is a fully remote position, open to applicants in New York.

📋 Description

• Establish and uphold treatment access for patients throughout their therapy journey.

• Spearhead the pull-through process on active cases through compliant actions that enhance access and accelerate treatment initiation.

• Collaborate directly with prescribing offices, contracted Specialty Pharmacies, the Patient Service Center, and sales team members.

• Recognize payer trends and notify business partners accordingly.

• Create, coordinate, and implement tactical plans to establish and sustain treatment access.

• Assist colleagues in understanding legal and regulatory frameworks related to anti-kickback statutes, fraud and abuse, off-label promotion, and OIG guidance for patient assistance programs.

• Prioritize business requirements, resolve intricate problems, cultivate customer relationships, and inspire suitable actions to advance cases.

• Support and educate healthcare provider (HCP) offices on best practices for the authorization process.

• Communicate with Specialty Pharmacies to enhance processing times and facilitate shipment scheduling.

⛳️ Requirements

• A minimum of 5 years’ experience with specialty pharmaceutical products, or at least 2 years’ experience in an access-related role outside of the pharmaceutical industry.

• Preferred experience in Ophthalmology, Nephrology, Rheumatology, Pulmonology, Neurology, or Dermatology.

• Strong comprehension of insurance and benefit design with both commercial and government payers.

• Background in Access & Reimbursement, Payer account management, Specialty Pharmacy distribution, Patient Services, or Case Management.

• Proven ability to navigate complex authorization processes for specialty medications successfully.

• Experience collaborating with a Patient Service Center/Hub to devise case-specific strategies based on payer mix, benefit design, and authorization requirements.

• Experience coordinating case pull-through efforts with Patient Service Centers, Case Managers, Sales teams, and Specialty Pharmacies.

• Field responsibility in supporting and educating HCP offices on best practices for the authorization process.

• Experience liaising with Specialty Pharmacies to enhance processing times and facilitate shipment scheduling.

• Proven analytical, problem-solving, and relationship-building skills.

• Exceptional communication, organizational, and leadership abilities.

• Customer interaction and field travel up to 60%; overnight stays may be necessary depending on geography.

• A Bachelor’s degree or higher is required.

🏝️ Benefits

• Competitive compensation and benefits through a comprehensive Total Rewards package.

• Bonus eligibility in accordance with the applicable program.