Director, Payer Relations

Johnson & Johnson Innovative Medicine•Santa Clara, MA

4d•$157,000 - $271,400•Remote

About The Position

About MedTech Fueled by innovation at the intersection of biology and technology, we’re developing the next generation of smarter, less invasive, more personalized treatments. Your unique talents will help patients on their journey to wellness. Learn more at https://www.jnj.com/medtech Remote work options may be considered on a case-by-case basis and if approved by the Company. Position Overview: The Director of Payer Relations is responsible for developing and managing strategic relationships with national and regional health plans and other third-party payers. This role ensures that Shockwave Medical’s products are positioned favorably with payers, networks, and reimbursement structures to maximize patient access and organizational revenue. The individual will also partner cross-functionally with members of the sales, marketing, and clinical affairs teams to inform the long-term evidence strategy required to obtain and maintain reimbursement in U.S. markets.

Requirements

Bachelor’s degree in public policy, health economics, or life sciences required; Master’s degree preferred.
7–10 years of healthcare coding, coverage, and reimbursement experience with medical devices; vascular or coronary experience is a plus.
Experience with complex reimbursement areas including Medicare and commercial payer policies and processes.
Demonstrated success in developing coverage for emerging technologies and influencing payer policies.
Strong understanding of clinical and economic data, coding, coverage, and payment issues.
Expertise in reimbursement principles across various healthcare settings (physician offices, hospitals, ambulatory surgery centers).
Willingness to travel 25–50% as required.
Excellent written and verbal communication skills.
Proficiency in Microsoft PowerPoint, Excel, and Word.

Responsibilities

Lead the development and execution of national and regional payer coverage and reimbursement strategies, including clinical data and publication requirements, health economics, and general value proposition models, to ensure successful payer negotiations, commercial viability, and improved patient access to covered IVL indications.
Engage with third-party evidence review organizations to ensure up-to-date reviews of Shockwave clinical data and provide education and materials in support of positive conclusions from clinical literature.
Develop and maintain strong relationships with target payers and build a working knowledge of their key processes including medical policy, utilization review, health outcomes, risk management, provider contracting, and claims processing.
Develop relationships with Advisory Committee members and payer Medical Directors (key influencers for our indications) for public and private payers to support changes that reflect local medical practices.
Influence policy development such as new Local Coverage Determinations (LCDs) and engage with various coverage advisory groups to enhance patient access.
Effectively leverage and communicate published literature and other evidence to payers, demonstrating IVL value that positively influences coverage policy development.
Monitor payer coverage policies, track review periods, and analyze data on medical review, prior authorization, and claims payment trends to inform payer strategy, tactics, and team priorities.
Collaborate with Field Reimbursement Managers as needed for ongoing strategy execution.
Support Clinical Education with lead local physician advocates to influence payer coverage and medical review policies.
Improve effectiveness and focus of industry alliances, as needed, that support Medicare and commercial payer policy and patient access.
Provide internal and external voice-of-customer (VOC) feedback to guide strategy development.
Develop programs to train Sales Representatives and key economic customers on reimbursement issues.
Perform other duties as assigned.

Benefits

The anticipated base pay range for this position is $157,000-271,400.00
The Company maintains highly competitive, performance-based compensation programs. Under current guidelines, this position is eligible for an annual performance bonus in accordance with the terms of the applicable plan. The annual performance bonus is a cash bonus intended to provide an incentive to achieve annual targeted results by rewarding for individual and the corporation’s performance over a calendar/performance year. Bonuses are awarded at the Company’s discretion on an individual basis.
Subject to the terms of their respective plans, employees are eligible to participate in the Company’s consolidated retirement plan (pension) and savings plan (401(k)). This position is eligible to participate in the Company’s long-term incentive program.
Vacation –120 hours per calendar year
Sick time - 40 hours per calendar year; for employees who reside in the State of Colorado –48 hours per calendar year; for employees who reside in the State of Washington –56 hours per calendar year
Holiday pay, including Floating Holidays –13 days per calendar year
Work, Personal and Family Time - up to 40 hours per calendar year
Parental Leave – 480 hours within one year of the birth/adoption/foster care of a child
Bereavement Leave – 240 hours for an immediate family member: 40 hours for an extended family member per calendar year
Caregiver Leave – 80 hours in a 52-week rolling period10 days
Volunteer Leave – 32 hours per calendar year
Military Spouse Time-Off – 80 hours per calendar year