Director- US Reimbursement

CSL•King of Prussia, PA

2d•Hybrid

About The Position

The Director, Reimbursement Strategy, is responsible for driving the successful translation of market access and reimbursement strategy into field execution to optimize patient access and therapy adoption. Serving as a strategic leader supporting Executive Leadership and across Field Reimbursement Managers (FRMs), this role identifies reimbursement trends, access barriers, and payer challenges while developing scalable solutions that improve pull-through across provider accounts, health systems, specialty pharmacies, and payer channels. The Director is a deep US reimbursement subject matter expert who partners extensively with Market Access, Patient Services, FRMs, Contracting, National Accounts, Trade, Specialty Pharmacy, Policy & Government Affairs, Medical Affairs, Legal, Compliance, and Commercial teams to ensure alignment between evolving payer policies and field execution. This individual serves as a key conduit for reimbursement insights, helping shape reimbursement strategies that enhance provider experience, accelerate patient access, and support organizational objectives. The ideal candidate combines deep reimbursement expertise with strong strategic thinking, cross-functional leadership, and a passion for improving patient access within complex specialty and rare disease environments.

Requirements

Bachelor's degree required.
Minimum of 10 years of pharmaceutical, biotechnology, specialty pharmacy, healthcare, or market access experience.
Minimum of 5 years of experience in reimbursement, patient access, field reimbursement, market access, or related functions.
Demonstrated experience working with commercial, Medicare, Medicaid, and specialty pharmacy reimbursement models.
Advanced knowledge of reimbursement and patient access processes, including: Prior authorizations, Appeals, Reauthorizations, Benefit investigations, Specialty pharmacy distribution, Medicare and commercial coverage pathways, Payer policy implementation
Strong understanding of: U.S. healthcare reimbursement environment, Market access strategy, Provider office workflows, Patient support services, Specialty therapeutic access models

Nice To Haves

Advanced degree (MBA, MHA, MPH, PharmD, or related field) preferred.
Experience supporting specialty, rare disease, biologic, or complex therapeutic products preferred.
Prior leadership, coaching, or project management experience preferred.
PACS Preferred

Responsibilities

Translate payer and market access strategies into actionable reimbursement and access initiatives for field teams and customers.
Develop strategic recommendations to address reimbursement challenges impacting patient access and therapy initiation.
Monitor changes in payer policy, utilization management criteria, reimbursement pathways, and healthcare regulations to assess business impact.
Collaborate with Market Access and payer-facing teams to support field pull-through of coverage and access strategies.
Identify opportunities to improve provider understanding of reimbursement requirements and access pathways.
Support strategic planning for new product launches, indication expansions, and reimbursement initiatives.
Serve as a strategic partner to Field Reimbursement leadership and FRMs by providing guidance on reimbursement trends, emerging access challenges, and complex account situations.
Identify systemic access barriers and develop scalable solutions that can be implemented across regions and customer segments.
Support field excellence initiatives to elevate reimbursement knowledge base across field based teams.
Facilitate consistency in reimbursement support approaches while maintaining compliance with company policies and industry regulations.
Act as an escalation resource for complex reimbursement and access-related situations requiring cross-functional collaboration.
Partner with market access and account teams to ensure payer coverage strategies are effectively translated into provider-level execution.
Assess gaps between coverage policy intent and real-world implementation and recommend solutions to improve patient access.
Support development of account-level reimbursement strategies for integrated delivery networks, specialty pharmacies, centers of excellence, academic institutions, and community-based providers.
Analyze payer landscape trends and identify opportunities to improve access outcomes and customer experience.
Collaborate on initiatives designed to reduce reimbursement friction and streamline patient access processes.
Lead collaboration across Patient Services, Market Access, National Accounts, Trade, Specialty Pharmacy, Policy & Government Affairs, Medical Affairs, Commercial Operations, Sales, Legal, and Compliance teams.
Ensure access-related insights from the field are incorporated into organizational strategy and decision-making.
Influence stakeholders across multiple functions without direct authority to achieve business objectives.
Participate in governance forums, strategic planning meetings, and cross-functional workstreams focused on patient access and reimbursement.
Analyze reimbursement, payer, and patient access data to identify trends, risks, and opportunities.
Develop and communicate actionable insights to leadership regarding coverage dynamics, reimbursement performance, and emerging market trends.
Establish and monitor key performance indicators related to access, reimbursement, and field effectiveness.
Utilize customer feedback and field intelligence to continuously improve reimbursement strategies and support models.