Director, Medical Device Reimbursement Strategy
Job Description
Description
About Pacira
Pacira BioSciences, Inc. is a leading provider of non-opioid pain management and regenerative health solutions dedicated to improving outcomes for health care practitioners and their patients. Our in-depth knowledge of non-opioid pain management, coupled with our passion for advancing patient care, drives our commitment to providing solutions that address unmet medical needs and improve clinical results.
Why work with us?
Rarely do you have an opportunity to do work that really matters. What drives us is our mission. What makes us successful are our people. At Pacira, you are part of an inclusive culture that fosters collaboration, growth, and innovative thinking - a place where you can make an impact and help change the standard of care in non-opioid pain management. Be part of our movement, let's pursue excellence together.
Summary:
This role is responsible for creating the overarching strategy for Pacira's Reimbursement and Market Access for its' medical devices and is both internal and external facing. This role will work across the various cross-functional stakeholders to coordinate execution of tactics that will result in the creation of the value and clinical story of Pacira's medical devices for the market, particularly payers. Building internal and external relationships and finding collaboration opportunities is essential to execute Pacira's broader medical device initiatives.
Essential Duties and Responsibilities:
- Create a strategy/ tactics for optimizing coverage by working with internal and external partners to best package and position existing evidence and data.
- Identify clinical and evidence gaps related to emerging coverage requirements for Pacira's medical devices.
- Partner with clinical and medical colleagues to identify immediate opportunities to create additional value collateral.
- Work closely with and provide guidance to clinical teams to ensure evidence generation activities/ clinical studies are aligned to broader market access and reimbursement goals.
- Ensure that organization can clearly deliver the medical device value message to the payer community: clearly understand the current reimbursement methodology and recommend changes needed to obtain best possible access for patients.
- Help identify obstacles with respect to Coding, Coverage and Reimbursement that prevent patient access to Pacira's medical devices. Work cross-functional to remove those obstacles.
- Work to gather voice of customer (VOC) feedback from external partners to understand real world impact and considerations.
- Partner with various field-based teams to gather continuous insight on market dynamics affecting medical device/ procedure product reimbursement and coverage.
- Translate insights from VOC/ payers/ societies into actional plans that shape value messages and tool development, including value dossiers, values briefs, and economics models
- Partner with the Insights & Analytics to stay abreast of key demographic, financial and market access trends that impact medical devices, access and reimbursement.
- Identify and implement opportunities to collaborate with Payers where possible.
- Build relationships with key major medical societies who help drive treatment guidelines. Understand how those guidelines influence payer decisions.
- Work with various associations, third party consultants and other payer and provider networks to find opportunities to educate the payer community. Build and manage relationships with high level influencers with key national and regional payers as well as their networks, including ACOs, ASC Chains, HOPD's and targeted Consulting Groups.
- Provide input and closely collaborate with marketing / field on product value propositions and outcomes needed to support reimbursement/ market access for our medical devices/ procedures.
- Coordinate with marketing and other functions on the development and oversight of reimbursement tools and support programs including digital, social, collateral, support, customer hotlines and educational programs, etc.
- Serve as a resource to coordinate the material development and communication of HEMA/ HEOR related materials/data to the field/ customers.
- Work closely with internal partners on pull-through opportunities with Payer customers on messaging and resources required to maximize patient access.
- Partner with field teams to help drive market access activities/ tactics, which include executing tactics to optimize market access, reimbursement and commercial success.
- Closely partner with Market Access, Strategic Customer, National Accounts, teams to drive two-way understanding of requirements, provide data, collaterals and programs.
- Be the internal "go-to" resource for medical device reimbursement.
Interaction:
This position will work closely with many internal departments, in particular with Clinical and HEMA/ HEOR partners, Field Market Access, Market Access Marketing, and multiple other cross-functional partners, including Medical Affairs, Commercial Marketing & Sales, Professional Education, Regulatory Affairs, and Legal; and with external consultants.
Qualifications:
- Proven ability to think strategically and succeed with indirect influence and independent direction
- Current and relevant working relationships with executive level decision makers at payers, societies, associations and Coalitions
- An in-depth understanding of key payer's process & medical policy
- Demonstrated understanding of CMS, Commercial payment models and trends.
- Understanding medical billing, coding, appeals, denials and single case / procedure rates
- Demonstrated ability to partner, communicate, and accomplish goals across an organization
- Proven problem-solving, analytic and negotiation skills with high value contacts and partnerships
- Excellent written and verbal English communication skills including presentation skills to groups of all sizes at executive levels
- Able to travel 50%+
Supervisory Responsibilities:
This role may have supervisory responsibilities.
Education and Experience:
- Bachelor's degree required; Health Policy, Finance, Business or related field a plus
- Minimum of 8 years related experience in the healthcare industry required
- Minimum of 5 years of relevant experience in reimbursement, market access or payer relations required
- Experience bringing medical device coverage from strategy development to execution and value creation in a dynamic organization is required
- Previous US market experience with a strong understanding of medical delivery systems, reimbursement, market access conditions and health policy trends that impact medical device and procedural coverage in the US is required
- Solid knowledge of evidence needed to drive favorable US reimbursement and market access for medical devices is required
Physical Demands:
While performing the duties of this job, the employee is regularly required to sit, talk, move between spaces, reach with hands and arms, and stoop. Close vision and the need to focus on computer screen, use of hands, fingers and wrist to type on keyboard and manipulate mouse.
Work Environment:
The role may include work from home or remote locations. This position may or may not be a typical office setting, staff in cubicles. Noise level is moderate such as consistent printer, telephone ringing, conversation, airport paging and airplane noise.
Benefits:
- Medical, Prescription, Dental, Vision Coverage
- Flexible Spending Account & Health Savings Account with Company match
- Employee Assistance Program
- Mental Health Resources
- Disability Coverage
- Life insurance
- Critical Illness and Accident Insurance
- Legal and Identity Theft Protection
- Pet Insurance
- Fertility and Maternity Assistance
- 401(k) with company match
- Flexible Time Off (FTO) and 11 paid holidays
- Paid Parental Leave
The base pay range for this role in California is $160,000 per year to $220,000 per year.
The range is what we reasonably expect to pay for this role. The range considers a wide range of factors that are considered in making compensation decisions, including but not limited to: geographic markets, business or organizational needs, skill sets, experience, training, licensure, and certifications.
EEO Statement: Pacira is proud to be an Equal Opportunity Employer and does not discriminate against applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), veteran status, disability or genetic information, or any other characteristic protected under applicable federal, state, or local law. At Pacira we are committed to intentionally cultivating a culture of inclusion where all feel welcomed and valued for their background, perspectives, and experiences. We hold one another accountable to promote trust and transparency in support of our communities and collective purpose.
Agency Disclaimer: Pacira Biosciences, Inc. (Hereafter, Pacira) does not accept unsolicited resumes from recruiters or employment agencies in response to the Pacira Careers page or a Pacira social media post. Pacira will not consider or agree to payment of any referral compensation or recruiter fee relating to unsolicited resumes. Pacira explicitly reserves the right to hire said candidate(s) without any financial obligation to the recruiter or agency. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Pacira.
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