National Account Director - Medicaid

Organon • Plymouth Meeting, PA

9d

About The Position

Organon is currently seeking a Director, Medicaid and to lead Medicaid payer engagement and drive broad access for the company’s Medicaid brands through their lifecycle. Responsible for managing the relationship Organon and state Medicaid programs, ensuring compliance with regulations, maximizing reimbursement, and driving product market access. The Director, Medicaid is responsible for developing and maintaining strong knowledge of state Medicaid, ensuring execution of pricing and contracting strategies, monitoring policy and regulation changes that would influence therapeutic areas, thorough understanding of P&T and DUR meetings by state as well as bid processes. This role requires the ability to understand and influence multiple stakeholders including Pharmacy Director, Medical Director, Clinical Pharmacy/Finance Directors, and P&T/DUR members with the end goal of rapid formulary inclusion of launch products, monitoring, ensuring, and providing updates by the states and ensuring unencumbered and affordable access for patients. This role will develop and execute account specific strategies for Regional Payer accounts and PBMs, primarily within the Medicaid channel. Internally, this role will collaborate cross functionally with sales, marketing, (Health Economics and Outcome Research), Contracting and Pricing and Payer Account Directors to ensure a balance between affordable and easy access for patients while meeting organization strategic goals. The Director, Medicaid plays a critical role in the delivery of product value proposition that demonstrates the clinical and economic value of Organon products. This role reports to the Executive Director, Market Access.

Requirements

• Bachelor’s degree in Business, Marketing, Economics, or Health sciences.
• Five to ten years of Account Management Experience.
• Minimum one to three years of people leadership, ideally in field-based Sales and/or Market Access Account Management experience, ideally inclusive of the Medicaid channel.
• Demonstrated experience gaining formulary access for a launch product at multiple regional and Medicaid payer accounts and PBMs.
• Understanding of Medicaid rebate compliance and reporting obligations, to ensure adherence and mitigate risk.
• Strong strategic mindset to develop and execute reimbursement strategies, identify opportunities, and anticipate and address potential challenges or barriers.
• Negotiation experience, preferably in competitive primary care and specialty therapeutic areas.
• Analytical mindset and history of leveraging HEOR (Health Economics and Outcome Research) data to articulate a value story that ensures rapid formulary coverage of launch products.
• Strong understanding of the payer landscape and how payer decision making impacts providers and their patients.
• Excellent oral, written and presentation skills with ability to influence decision makers and explain complex concepts clearly to a variety of audiences.
• Familiarity with current legal and regulatory landscape pertinent to the industry.
• Travel 50%.

Responsibilities

• Medicaid Program Management: Oversee and manage Organon’s engagement with state Medicaid programs, including understanding program, management, requirements, policies, and regulations. Ensure effective communication to key payer stakeholders, decision makers and Regional Account team regarding label changes, pricing, bids, product information etc. Understand dynamics of the PBM/state Medicaid relationships, Managed Medicaid plans, and key decision makers; have a thorough understanding of Medicaid pools and states under these pools, work with Regional Account Team on execution of managed Medicaid contracts and pull through. Understand dynamics of the PBM/state Medicaid relationships, Managed Medicaid plans, and key decision makers; have a thorough understanding of Medicaid pools and states under these pools, work with Regional Payer team on execution of managed Medicaid contracts and pull through. Attend P&T/DUR meetings and understand Committee dynamics, for priority Medicaid states, and level of influence each has over decisions (i.e. statewide PDL, exemption state, etc.)
• Reimbursement Strategy: Execute strategies to maximize product access and reimbursement within state Medicaid programs, working closely with cross-functional teams such as pricing, market access, and government affairs.
• Medicaid Contract Execution and Management: Collaborate with state Medicaid agencies and managed care organizations to negotiate favorable access, contract terms, pricing agreements, and formulary placements for Organon products. Execute the Medicaid engagement strategy and leverage Medicaid and Payer Value Proposition to obtain appropriate access/formulary position among targeted states or accounts. Negotiate, execute, and monitor contract initiatives and performance to optimize net sales for Organon products including but not limited to state Medicaid, Reginal Payer, Managed Medicaid agreements, PBM and Health plan agreements. Leverage and refine data analysis tools to model the addition of Organon products to customer formularies, evaluating both Organon and customer POV to provide a complete financial assessment. Communicate consistently with brand, payer brand marketing, senior leadership, state government affairs, legal, finance, and other HQ personnel to share insights and segment specific expertise critical to purposeful business decisions.
• Compliance and Regulatory Adherence: Ensure compliance with Medicaid regulations, policies, and requirements.
• Stakeholder Relationship Management: Collaborate with the Payer and Commercial Sales teams to build and maintain strong relationships with state Medicaid agencies, government officials, pharmacy benefit managers (PBMs), and advocacy organizations to advocate for the Organon’s products and address any reimbursement or access challenges. Profile key payer accounts to assess formulary review process, formulary coverage policies, utilization management deployed for the applicable therapeutic areas, and geographic coverage areas.
• Market Access and Reimbursement Analysis: analyze reimbursement trends and evaluate the impact of policy changes on product access and reimbursement. Use this information to inform business strategies and tactics. Identify and address potential barriers to access proactively to ensure launch product is well positioned for formulary and P&T and DUR reviews.
• Formulary Management: Collaborate with internal teams and external stakeholders to secure optimal formulary positions and coverage for the Organon products within state Medicaid programs. Identify competitive threats and develop strategies to ensure optimal coverage for Organon portfolio of products Lead pull-though initiatives that capitalize on formulary wins and lead push-though efforts in areas with access challenges
• Training and Education: Provide training and education to internal teams, sales leaders, and healthcare providers on Medicaid policies, reimbursement guidelines, and program-specific requirements.
• Cross-functional Collaboration: Collaborate with internal teams, including sales, marketing, legal, regulatory affairs, state government affairs, and medical affairs, to align strategies, ensure compliance, and drive business objectives related to Medicaid programs. Ensure compliance with Organon corporate policies and procedures and U.S. healthcare laws and regulations.

Benefits

• Benefits offered in the U.S. include a retirement savings plan, paid vacation and holiday time, paid caregiver/parental and medical leave, and health benefits including medical, prescription drug, dental, and vision coverage in accordance with the terms and conditions of the applicable plans.

What This Job Offers

• Job Type: Full-time
• Career Level: Director