Director – Medical Policy

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

📋 Description

• Oversee and evaluate payer and LBM medical policies, coverage decisions, and reimbursement trends across commercial and government payers to determine their impact on the company's pipeline.

• Analyze payer and policy changes and relay their implications to internal stakeholders.

• Serve as a clinical and product expert for the Market Access team, responsible for presenting clinical data to market access policymakers, including Medical Directors and Medical Policy groups, at meetings and conferences.

• Lead and assist in the creation of evidence generation plans, value propositions, and technical assessment submission packages to secure coverage for Caris products with designated payers and LBMs.

• Engage with payer stakeholders such as Medical Directors and Medical Policy contacts to communicate data updates and advocate for coverage of Caris's tests.

• Maintain relationships with industry policy stakeholders, including trade associations and professional societies.

• Support national and state legislative initiatives that advocate for coverage of evidence-based biomarkers for all cancer patients to enhance access and promote health equity.

• Represent and advocate for Market Access in strategic and tactical planning within the business units, emphasizing evidence generation, product development, and commercialization from a payer perspective.

• Collaborate with market access, marketing, HEOR, and other related solutions teams to facilitate the execution of business plans for the business unit.

• Monitor and comprehend professional society guidelines and technology assessments that affect payer policy decisions.

• Demonstrate the ability to work in a fast-paced, deadline-driven environment, managing multiple projects efficiently and within budget.

• Utilize expert knowledge and judgment to make informed decisions.

• Effectively collaborate, interface, and influence all levels of the internal organization.

• Independently and proactively lead, manage, and prioritize strategies, initiatives, and workloads in a dynamic, entrepreneurial environment.

• Adapt to change and work effectively in ambiguous situations, responding to new information and unexpected developments.

• Develop a compelling value proposition and effective business case to influence medical policy.

• Apply exceptional problem-solving, project, and program management skills.

• Exhibit strong analytical and business acumen, with the ability to communicate effectively with high-level executives.

• Demonstrate strong collaboration, influencing, project management, organizational, and change management skills.

• Possess strong oral and written communication and presentation abilities.

• Uphold the company's mission and values through accountability, innovation, integrity, quality, and teamwork.

• Maintain consistent and reliable attendance.

• Develop and sustain payer engagement strategies to support long-term access and reimbursement objectives.

• Conduct internal training sessions to inform commercial and medical teams about payer trends and policy changes.

• Monitor and report on key performance indicators (KPIs) related to payer coverage, policy successes, and access milestones.

• Collaborate with Clinical Development and HEOR to align evidence generation with payer expectations.

• Support the development of pricing strategies by offering insights into payer value perceptions and reimbursement benchmarks.

• Represent the company at external policy forums, payer advisory boards, and industry coalitions.

⛳️ Requirements

• An advanced clinical or scientific degree (e.g., PharmD, PhD, MS in Genetic Counseling, NP, PA, or equivalent).

• A minimum of 7 years of experience in medical policy, market access, or related positions within biotech, diagnostics, or healthcare.

• Proven experience in engaging with payers, including Medical Directors and policy decision-makers.

• In-depth knowledge of U.S. healthcare reimbursement systems, including CMS and commercial payers.

• Demonstrated ability to create and communicate evidence-based value propositions.

• Excellent analytical, communication, and presentation skills.

• Experience working collaboratively in a matrixed organization.

• Profound scientific understanding and practical application of oncology biomarkers and companion diagnostics.

• Strong comprehension of digital health and real-world evidence generation.

• Ability to convey technical and non-technical information to both scientific and non-scientific colleagues/clients.

• Strong interpersonal and peer leadership skills to influence without direct authority.

• A strategic thinker with exceptional verbal, written, and presentation skills to secure buy-in and foster consensus within the team and organization.

🏝️ Benefits

• Highly competitive and inclusive medical, dental, and vision coverage options.

• Health Savings Account for medical expenses and dependent care expenses.

• Flexible Spending Account to cover certain out-of-pocket costs.

• Paid time off, encompassing vacation, sick leave, and holidays.

• 401k matching and financial planning tools.

• Long-term and short-term disability insurance coverages, along with voluntary benefit options.

• Employee Assistance Program.

• Pet Insurance.

• Legal Assistance.

• Tuition Assistance.