Access and Reimbursement Manager (San Francisco/Sacramento)
About The Position
The Access and Reimbursement Manager (ARM) helps create and maintain patient access to treatment throughout the course of therapy. While the sales specialist drives new business demand, the ARM leads the pull-through process on open cases by taking compliant actions that improve access and expedite treatment starts. The ARM works directly with prescribing offices, contracted Specialty Pharmacies, the Patient Service Center, and sales colleagues. The ARM identifies payer trends, alerts business partners, and develops, coordinates, and executes tactical plans to create and maintain treatment access. Drawing on leadership and access expertise, the ARM serves as a valuable resource to colleagues and customers. The role requires consistently demonstrating ethics and integrity and helping others understand legal and regulatory parameters related to anti-kickback statutes, fraud and abuse, off-label promotion, and OIG guidance on patient assistance programs. The ideal candidate can prioritize business needs, solve complex problems, build strong customer relationships, motivate others to move cases forward, and adapt quickly to changing business needs in a fast-paced environment. Customer interaction and field travel may reach 60%, with overnight travel dependent on geography.
Requirements
- At least 5 years of experience working with specialty pharmaceutical products, or at least 2 years in an access-related position outside of pharma.
- Strong understanding of insurance and benefit design with commercial and government payers.
- Background in Access & Reimbursement, payer account management, Specialty Pharmacy distribution, Patient Services, or Case Management.
- Experience navigating complex authorization processes for specialty medications.
- Experience working with a Patient Service Center/Hub to design case-specific strategies based on payer mix, benefit design, and authorization requirements.
- Demonstrated analytical, problem-solving, and relationship-building skills.
- Excellent communication, organizational, and leadership skills.
- Bachelor’s degree or higher required.
- Ability to travel for customer interaction and field responsibilities up to 60%; overnight travel depends on geography.
Nice To Haves
- Experience in one or more of the following therapeutic areas: Ophthalmology, Nephrology, Rheumatology, Pulmonology, Neurology, or Dermatology.
Responsibilities
- Lead pull-through on open cases through compliant actions that improve access and expedite patients’ starts to treatment.
- Work directly with prescribing offices, contracted Specialty Pharmacies, the Patient Service Center, and sales colleagues to support treatment access.
- Identify payer trends, alert business partners, and develop, coordinate, and execute tactical plans to create and maintain access to treatment.
- Help colleagues understand legal and regulatory parameters related to anti-kickback statutes, fraud and abuse, off-label promotion, and OIG guidance on patient assistance programs.
- Coordinate case pull-through with the Patient Service Center, Case Managers, Sales, and Specialty Pharmacies.
- Support and educate HCP offices on best practices that streamline authorization processes and expedite patient access.
- Communicate with Specialty Pharmacies to improve processing time and facilitate shipment scheduling.
- Prioritize business needs, solve complex problems, build customer relationships, and motivate others to move cases forward.
- Adapt to evolving business needs.
- Travel for customer interactions and field responsibilities, up to 60%; overnight travel depends on geography.
Benefits
- Competitive pay and benefits as part of a Total Rewards package.
- Eligible for a bonus in accordance with the applicable program; bonuses are awarded at the Company’s discretion.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
