Director – Head of Patient Access & Reimbursement

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as a strategic leader to establish and manage a Patient Access & Reimbursement field team aligned regionally.

• Recruit, onboard, and oversee the training process for the field team.

• Collaborate with the cross-functional Commercial leadership team to define the field-based role and operational methods.

• Build a field-based patient access team that acts as a strategic ally for HCPs and care sites, providing billing and coding reimbursement education to enhance the patient access experience for DMD families.

• Set access objectives, productivity metrics, and ensure the formulation and execution of account plans on a quarterly and annual basis.

• Work in partnership with cross-functional teams, including Commercial Operations, to track patient scripts through the fulfillment process.

• Collaborate with the Patient Services lead to promptly identify and resolve access issues.

• Foster a continuous learning and development environment for the field-based team.

• Work alongside Trade and Patient Services leaders to identify efficiencies in processes with all third-party service providers.

• Assist in the creation of stakeholder analytics and Key Performance Indicators (KPIs) to enhance forecasting, contracting, pricing decisions, timing, and overall business planning.

• Develop a thorough understanding of site capabilities, operational gaps, and create plans to address these gaps in partnership with HCPs and care sites.

• Engage with institutional leadership, administration, revenue cycle management, finance, managed care teams, contracting, pharmacy, prior authorization departments, and care teams.

• Support HCP champions through the formulary inclusion process and monitor Pharmacy and Therapeutic Committee timelines to ensure site readiness.

• Responsible for removing or significantly mitigating barriers to patient access and reimbursement for Capricor’s product portfolio across all payer segments.

• Assist in high-touch patient and caregiver support programs, including managing site of care referrals, travel logistics, and patient affordability initiatives.

• Aid in developing training materials, Standard Operating Procedures (SOPs), and work instructions as necessary to educate on Capricor's channels and patient support offerings.

• Onboard to ensure that all care sites are operationally confident with Capricor's buy-and-bill and Specialty Pharmacy procurement processes, reimbursement support services, and tools, including best practices for prior authorization/reauthorization patient enrollment and navigating the denial/appeal processes.

• Collaborate with Sales leadership to recognize access challenges and devise solutions.

• Ensure understanding and adherence to Capricor’s Legal and Compliance guidance concerning access, cost, and reimbursement issues at both customer and field leadership levels.

• Participate in regional sales meetings to represent the Patient Access & Reimbursement team.

• Regularly update Capricor Senior Leadership on the health of the launch, key access issues, and collaborative solutions implemented to address known access challenges.

• Support distribution provider and vendor quarterly and annual business reviews, along with analytical insights for company reporting.

• Monitor competitors to assess how the evolving market may influence current and future market access strategies.

• Identify and cultivate relationships with Provider Access and Patient Advocacy Groups, Physician Key Advocate Leaders (KALs), and societal advocates to promote disease/product awareness and patient access to Capricor’s product offerings.

• Provide subject matter expertise to the broader organization, covering HCP access and reimbursement, distribution, and payer coverage access intelligence. This includes supporting corporate training initiatives, content, tools, and presentation development in partnership with Training and Cross-Departmental leaders.

• Collaborate with the Capricor Commercial Ops/analytics team and Sales to track and report updates in HCP/Patient access, patient referrals, SPP distribution, trend monitoring, and patient out-of-pocket information.

• Represent Capricor at significant industry conferences (e.g., Asembia, Physician Society, Patient Advocacy, etc.).

• Ensure that all activities and interactions adhere to the highest ethical and professional standards, and that all work is performed with quality in line with Capricor values.

• The Director will report to the SVP of Market Access and will play a crucial role in supporting key business decisions throughout the organization.

⛳️ Requirements

• A minimum of a Bachelor’s degree is required; a degree in sciences or business is preferred, and an MBA or advanced degree is a plus.

• At least 10+ years of overall industry experience in BioPharma or Healthcare services (such as hospital patient case management, patient support, provider reimbursement, market access, sales, sales management, or training).

• A minimum of 5 years of progressive experience in patient support, payer (government and commercial) and PBM, as well as specialty pharmacy engagement and patient case management responsibilities.

• Proven leadership experience, having successfully led high-performing, self-directed teams.

• Experience with rare/orphan drugs is essential; familiarity with pediatric infused drugs is a plus.

• Experience with product launches is required, while experience in a startup environment is preferred.

• Demonstrated expertise in reimbursement, coding, claims adjudication, prior authorization processes, appeals management, and provider education.

• A deep understanding of specialty pharmacy, buy-and-bill distribution models, payer policies, government and commercial reimbursement, and the changing landscape of healthcare access.

• Strong knowledge of provider economics, hospital finance, revenue cycle management, and infusion site operations.

• Familiarity with compliance concerning HIPAA and OIG guidance in the rare disease sector.

• Experience in hospital finance, claims processing, and/or billing/coding is preferred.

• Excellent working knowledge of patient support programs, including reimbursement support, financial assistance, and adherence programs.

• Strong understanding of the prior authorization process, denial management, product acquisition through specialty pharmacy, buy-and-bill, IV infusion J-coding, and reimbursement across various care settings.

• Knowledge of both the buy-and-bill process and specialty pharmacy networks, managed care, benefit design, and government payers, along with their impact on product access, accompanied by a solid understanding of the evolving market access and reimbursement landscape.

• Demonstrated adaptability to changing environments, the ability to implement innovative solutions to complex challenges, and capability to function in a project leadership role.

• Ability to foster and maintain strong internal and external relationships, including direct collaboration with vendors and other third parties.

• Strong interpersonal, communication, analytical, and presentation skills, with meticulous attention to detail.

• Experience in developing and managing a functional budget, ensuring efficient resource allocation to meet strategic patient support goals.

• Strong business acumen and a compliance-oriented mindset.

• A passion for patients and a commitment to building a new commercial organization.

• Advanced skills in virtual communication platforms (e.g., Zoom), Microsoft Excel, Word, and PowerPoint.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance plans.

• Opportunities for professional development and career advancement.

• Flexible work arrangements to support work-life balance.

• Engaging company culture focused on innovation and collaboration.