Director, Advanced Therapy Payor Access
About The Position
About Shields Advanced Therapies Shields Advanced Therapies partners with health systems to accelerate advanced therapy access and operations, ensuring lifechanging breakthroughs reach more patients. Our management services and technology solutions serve as a horizontal support hub to empower health system-led, world-class advanced therapy care across 50+ disease states. Launched in September 2024, Shields Advanced Therapies is anchored by partnerships with four of the Top 20 Academic Medical Centers in the United States. Additionally, Shields' track record partnering with over 1,000 hospitals across 43 states in prior ventures provides a national channel for expansion. Role Overview The Director, Advanced Therapy Payor Access will build and lead the Payor Access function of Shields Advanced Therapies, serving as an executive resource to our Boston-based Health System Partner's constituents and payors. The role will be responsible for overseeing advanced therapy contracting operations, working in partnership with Health System Partners to develop and execute a reimbursement strategy across all advanced therapies, and establishing systems to streamline the management of this function. This position will initially focus on our Boston-based Health System Partner, but ultimately expand to a national function supporting health systems across the entire Shields network. This is a foundational and high visibility role within the Shields Advanced Therapies leadership team with direct exposure to executive leadership.
Requirements
- The ideal candidate will have 8-10+ years of experience in health system managed care or payor contracting, at a payor, and with domain knowledge of cell and gene therapies.
Responsibilities
- Build and lead national Payor Access function including strategy, processes, and team
- Develop, operationalize, and execute strategy for function that is aligned with broader company strategy and roadmap, including goals and tactical plan
- Codify workflows and operational processes into replicable playbook
- Recruit, hire, train and manage personnel to achieve objectives of function
- Establish systems for management of function, including central document management, project management, and pipeline monitoring
- Partner with Boston-based Health System's managed care team to ensure network contract and/or single case agreement access across all advanced therapies
- Serve as liaison between Boston-based Health System and payors for advanced therapy initiatives
- Facilitate the drafting and negotiation of single case agreements
- Partner with Boston-based Health System to develop and execute access and payment model strategy across key initiatives, including: Outpatient model alignment Center of excellence positioning Alternative payment models Restricted network access Charge, rate & billing strategies to optimize reimbursement
- Partner with Boston-based Health System and Shields leadership team to develop business plans, including underwriting payor-level unit economics for new therapies
- Codify product grid with coverage, contract provisions, and other key protocols by payor
- Establish standard contract templates where possible
- Renegotiate existing agreements on a regular cadence/when appropriate
- Establish systems for management of function, including a central document management system for contracts and other relevant documents, and a tracking tool
Benefits
- Competitive base salary with bonus opportunity tied to outcomes metrics.
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What This Job Offers
Job Type
Full-time
Career Level
Director
Education Level
No Education Listed
