Director - Payor Relations - Regional

Sight Sciences•,

About The Position

The Director, Payer Relations – Regional develops and executes regional payer engagement and coverage strategy for the TearCare® System. The role builds sustained relationships with Medicare Administrative Contractors, regional commercial health plans, Blue Cross and Blue Shield plans, Medicaid organizations, integrated delivery networks, and other healthcare decisionmakers to advance appropriate patient access and establish clear, evidence-based coverage policies. The Director translates national Market Access priorities into focused regional plans; leads payer discussions about TearCare clinical evidence, coding, coverage, and payment; and coordinates cross-functional resources to address policy barriers. As the regional payer-relations lead, the Director develops engagement plans, monitors policy activity, prepares coverage submissions, and communicates actionable payer insights to executive and commercial leadership.

Requirements

Bachelor’s degree in health policy, healthcare administration, business, life sciences, health economics, public health, or a related field.
At least 8 years of progressive experience in payer relations, market access, reimbursement, health policy, managed care, medical affairs, health economics, or a related healthcare field, including leadership of payer-facing initiatives.
Demonstrated experience engaging public and commercial payer stakeholders, including medical directors, policy teams, reimbursement leaders, or technology-assessment functions.
Demonstrated experience influencing or supporting coverage-policy development, policy reconsideration, evidence review, or payer medical-policy processes.
Strong working knowledge of Medicare and commercial payer policy infrastructure, medical policy development, coding, coverage, payment methodologies, claims processes, and provider reimbursement.
Experience translating clinical and economic evidence into payer-relevant materials, presentations, and strategic recommendations.
Experience leading cross-functional projects with Sales, Medical Affairs, Clinical, Regulatory, Legal, Compliance, Government Affairs, and Marketing partners.
Experience managing regional strategy, multiple payer accounts, external partners, and executive-level communications.
Executive presence and credibility with payer medical, policy, and reimbursement decisionmakers.
Excellent written, verbal, presentation, negotiation, and relationship-management skills.
Ability to evaluate coverage policies and complex clinical, coding, claims, and reimbursement information and convert findings into practical action plans.
Strong strategic judgment, accountability, organization, and ability to operate independently in a field-based leadership role.
Ability to manage competing priorities, navigate ambiguity, and escalate material risks or decisions promptly.
Commitment to accurate, evidence-based, non-promotional, and compliant payer engagement.
Proficiency with Microsoft Office, CRM platforms, policy-tracking resources, and virtual meeting tools.

Nice To Haves

Advanced degree.
Experience in medical devices, ophthalmology, specialty physician-administered procedures, diagnostics, or another coverage-policy-intensive healthcare category.

Responsibilities

Develop and execute regional payer-relations strategy for TearCare aligned with Market Access, commercial, clinical, medical, legal, and compliance priorities.
Prioritize regional payer organizations based on patient impact, policy opportunity, access barriers, provider needs, and business priorities; maintain account-specific engagement and coverage plans.
Build and maintain professional relationships with payer medical directors, policy leaders, reimbursement teams, provider-relations leaders, applicable pharmacy or technology assessment committees, and other economic decisionmakers.
Lead compliant payer meetings and discussions focused on TearCare clinical evidence, patient population, treatment pathway, coding, coverage, payment, health-economic considerations, and provider experience.
Monitor payer coverage policies, medical policies, clinical criteria, technology assessments, coding edits, prior-authorization requirements, and reimbursement practices affecting TearCare.
Develop and coordinate payer coverage submissions, reconsideration requests, evidence dossiers, policy comment letters, and follow-up responses using approved materials.
Engage Medicare Administrative Contractors and other government payer stakeholders in the assigned region regarding coverage, coding, payment, claims experience, and provider-access barriers in accordance with applicable requirements.
Partner with Medical Affairs, Clinical, Health Economics and Outcomes Research, Regulatory, Legal, and Compliance to identify evidence needs and ensure payer communications are accurate, balanced, substantiated, and compliant.
Convert payer feedback and policy trends into recommendations for evidence generation, publication strategy, value messaging, reimbursement tools, provider education, and account prioritization.
Coordinate with Field Reimbursement Managers and Sales leadership to identify regional access barriers, distinguish account-level reimbursement issues from payer-policy issues, and establish escalation and follow-up pathways.
Provide payer-policy interpretation and strategic guidance to internal stakeholders while avoiding guarantees of coverage or payment and preserving payer-specific nuance.
Create executive-ready regional updates covering payer engagement, policy status, barriers, opportunities, risks, decisions needed, and next actions.
Represent Sight Sciences at payer meetings, medical society discussions, healthcare policy forums, and other relevant external engagements as assigned.
Maintain accurate and timely documentation of payer interactions, policy milestones, commitments, evidence requests, and follow-up actions in approved company systems.
Manage regional payer-relations projects, external consultants, budgets, and deliverables as assigned, ensuring work stays within approved scope and compliance requirements.
Mentor regional Market Access colleagues and contribute to consistent payer-engagement standards, tools, training, and best practices.
Carry out duties in accordance with company policies and procedures and applicable laws and regulations governing interactions with healthcare professionals, payers, and government entities.