Manager, Coverage Analysis & Budget

Sutter Health•Sacramento, CA

About The Position

Under the direction of the Director, Clinical Trials Administration, the Manager, Coverage Analysis and Budget leads and performs clinical research pre-award activities associated with Medicare coverage analysis, protocol-driven budget development, sponsor and clinical research organization negotiation, financial feasibility, and alignment of study financial terms with institutional requirements. The manager is accountable for the quality, timeliness, and consistency of coverage analyses and budgets across an active enterprise research portfolio. This is a working manager role. In addition to leading staff and daily operations, the incumbent maintains an assigned portfolio and serves as the escalation point for complex oncology, cardiovascular, device, multi-arm, and other high-risk studies. The manager partners with research operations, contracting, legal, compliance, finance, revenue cycle, Epic teams, investigators, and external sponsors to move studies from protocol intake through executable budget terms and activation readiness. The manager establishes standardized workflows, workload controls, quality review, training, performance expectations, and key performance indicators. The role also provides subject-matter expertise regarding Medicare Clinical Trial Policy, National and Local Coverage Determinations, device coverage categories, coding and billing considerations, payer allocation, research cost identification, and clinical trial financial practices.

Requirements

Bachelor's degree in Accounting, Finance, Business Administration or related field, or equivalent experience.
5 years recent relevant experience.
Advanced knowledge of clinical research pre-award operations, protocol interpretation, Medicare coverage analysis, clinical trial budgeting, sponsor negotiation, and research billing compliance.
Working knowledge of the Medicare Clinical Trial Policy, Medicare coverage guidance, National and Local Coverage Determinations, investigational device concepts, medical coding, payer requirements, and Good Clinical Practice.
Ability to translate complex protocols into auditable coverage and financial decisions and to explain those decisions to clinical, financial, compliance, and executive audiences.
Strong people leadership, workload management, judgment, negotiation, conflict resolution, written communication, and stakeholder management skills.
Advanced analytical capability with financial models, pricing assumptions, variance review, performance metrics, and data-informed process improvement.
Ability to manage multiple priorities, make complex and sensitive decisions independently within delegated authority, and escalate material compliance, financial, or operational risk appropriately.

Responsibilities

Leads and performs clinical research pre-award activities associated with Medicare coverage analysis, protocol-driven budget development, sponsor and clinical research organization negotiation, financial feasibility, and alignment of study financial terms with institutional requirements.
Accountable for the quality, timeliness, and consistency of coverage analyses and budgets across an active enterprise research portfolio.
Maintains an assigned portfolio and serves as the escalation point for complex oncology, cardiovascular, device, multi-arm, and other high-risk studies.
Partners with research operations, contracting, legal, compliance, finance, revenue cycle, Epic teams, investigators, and external sponsors to move studies from protocol intake through executable budget terms and activation readiness.
Establishes standardized workflows, workload controls, quality review, training, performance expectations, and key performance indicators.
Provides subject-matter expertise regarding Medicare Clinical Trial Policy, National and Local Coverage Determinations, device coverage categories, coding and billing considerations, payer allocation, research cost identification, and clinical trial financial practices.