Director, Field Reimbursement (National)

Cesna Recruitment

2d•$200 - $240

About The Position

Field Reimbursement Director reports to the VP of Access Operation. The Field Reimbursement Director will oversee and manage a team of Field Reimbursement Managers (FRM) across assigned territories, ensuring that all aspects of reimbursement strategies are executed effectively to maximize product access and coverage. The Director will act as a key leader responsible for the coordination of field-based reimbursement efforts, offering strategic direction, support, and leadership to ensure the team is successful in navigating payer landscapes, insurance policies, and reimbursement processes.

Requirements

Bachelor's degree in business, healthcare, or related field.
Minimum of 10 years of experience in pharmaceutical reimbursement, managed care, or related field, with at least 5 years of experience in a leadership role.
Strong knowledge of healthcare reimbursement policies and procedures.
Ability to develop and implement reimbursement strategies.
Excellent communication and interpersonal skills.
Strong analytical skills and ability to analyze data and trends.
Ability to lead and manage a team and work collaboratively with cross-functional stakeholders.
Ability to work independently and in a team environment.
Willingness to travel as required.

Nice To Haves

Immunology and/or Oncology experience a plus

Responsibilities

Leading and managing the FRM team to ensure proper execution of reimbursement strategies, ensuring patient access to products across all geographies.
Developing and implementing reimbursement strategies to guarantee appropriate coverage and access for company products.
Working closely with healthcare providers, payers, and patients to ensure the products are covered by insurance plans.
Reviewing and approving complex reimbursement cases and assisting FRM team members in resolving coverage challenges and issues.
Monitoring payer policy changes, ensuring alignment with product reimbursement strategies and working with internal teams to address any potential barriers.
Analyzing payer trends, identifying areas for improvement, and adjusting strategies to ensure the continued success of reimbursement efforts.
Collaborating with external teams to identify and implement funding or financial assistance programs that support patient access to treatments.
Supporting the team in handling prior authorizations, appeals, and denials, and ensuring all necessary documentation is submitted in a timely and compliant manner.
Reviewing patient-specific cases, identifying challenges, and recommending solutions in collaboration with healthcare providers and internal teams.
Conducting both quantitative and qualitative analysis of FRM team activities and providing detailed reports to VP of Access Operation.
Based on progress analysis, identifying and implementing improvements to optimize the team's performance and enhance the overall reimbursement process.