Assoc. Director, Reimbursement & Access (RAD)
Description
SUMMARY: Cornerstone Search Group’s HEOR/Market Access/RWE/Data Science practice has been retained by a profitable, commercial-stage, and publicly-traded rare and ultra-rare disease pharma for an Associate Director, Reimbursement and Access (RAD) field-based position that covers the West region. This role reports to a personable and highly-experienced Reimbursement leader with whom we have previously partnered. We know first-hand about this company’s positive work culture from helping them to hire multiple professionals as they have grown. This is a proverbial “Best of Both Worlds” opportunity to join a smaller company with the benefits of interacting with senior management and “having a voice” while simultaneously enjoying the stability of working for a publicly-traded, profitable, commercial stage pharmaceutical company with attractive benefits and time-off policies.
The Reimbursement and Access team is considered by senior company leadership to be a critical component of the company’s commercial strategy and is responsible for supporting patient and healthcare provider (HCP) access to the company’s rare and ultra-rare disease therapies by providing education and support around payer coverage guidelines and navigation through complex approval and appeals processes. In this role, you will support patients and healthcare providers (HCPs) across sites of care in the West region to gain access to the company’s treatments. Our client is highly regarded for ensuring that HCPs have the most up-to-date information when prescribing and working through the approval and logistics processes. To do so successfully, this company’s RADs are their region’s expert in patient access, reimbursement, prior authorization appeal, obtaining financial assistance, and navigating through any complex access related issues.
Features
(1) This is a “rare” rare-disease small pharma that has multiple approved drugs, is publicly traded, and is profitable Unlike many small pharmas which are pre-commercial, our client enjoys the stability that comes from having already launched multiple drugs, is profitable, and is publicly-traded.
(2) Strong Culture: We have partnered with this client previously and have been impressed by their leadership stability (which is quite unusual in this day and age) and the collaborative culture they have forged, which has been greatly enjoyed by the people we have helped them hire. They have done an exemplary job of building a management team of team-first, high EQ leaders who are passionate about working in the rare disease sector and enjoy working with each other. Many of them had in fact worked together at prior companies. The hiring manager for this position has been with the company for over 5 years and had previously worked with senior management at a prior company.
(3) Strong Benefits: Our client offers an attractive range of benefits including stock (RSUs rather than risky options) upon joining, your choice of a car or car stipend, generous time off (including the week between XMAS and New Year’s), a 401(k) match that vests immediately, affordable health insurance, and even pet insurance, your choice of a work cell phone or cell phone stipend, etc.
Responsibilities
- Handle all coverage, reimbursement, and access needs within the West region.
- Work collaboratively externally with HCPs and Specialty Pharma partners and internally with RAMs, Patient Advocates, Hub Case Managers, National Account Directors (NADs), and Head of Sales.
- Proactively track patients from submission of enrollment form through to shipment in order to identify potential issues and reach timely resolutions.
- Provide training / education to HCPs on payor-specific coverage policies, authorization documentation requirements, appeals processes, and patient financial assistance support programs.
- Work directly with Hub vendor to understand payer coverage issues and assist with prior-authorization (PA) denials and appeals by working with HCP MDs and staff, helping to prepare HCPs for Peer-to-Peer needs.
- Work with HCPs and specialty pharmacies to overcome quantity limits or high dollar overrides.
- Escalate payer coverage or payment issues to the NAD, providing detailed specifics on issues, steps attempted to resolve, and identify key items that need addressing with the payer.
- Communicate opportunities and challenges related to patient access, as well as issues and status to internal stakeholders and leaders (e.g., Head of Sales).
- Collaborate with commercial colleagues to improve access and reimbursement tools.
- Contribute to the development of strategies, tactics, and messaging that will optimize their products’ benefits and differentiate them from competitors.
DESIRED SKILLS, EXPERIENCES & QUALIFICATIONS:
- BA/BS degree
- Ideally 3+ prior years in a Field Reimbursement and Access field-based role, including experience with prior authorization and multi-level appeals.
- Ideally complex pull-through experience with a buy-and-bill biologic (physician-administered, IM/SC injectable, IV injection, infusion).
- Ideally rare or ultra-rare disease experience.
- Immunology experience is a plus.
- Ideally experience communicating payer coverage criteria and prior authorization/appeals processes to HCPs and staff including prepping HCPs for Peer-to-Peer discussions.
- Ideally experience working with Specialty Pharmas to resolve access issues.
- Experience working with a Hub.
- Demonstrated ability to apply reimbursement knowledge to address/resolve patient access barriers.
- Strong Emotional Intelligence: Possess the skills necessary to resolve conflicts, build strong internal and external working relationships, and multi-task effectively.
- Seeking someone passionate about helping patients in the rare disease and ultra-rare disease communities they focus on.
Contact
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