Fully Remote
ESSENTIAL JOB FUNCTIONS
The Director, Payer Relations develops and executes U.S. payer engagement strategies that secure, expand, and sustain appropriate coding, coverage, payment, and patient access for the company's current and future medical technologies. The role builds strategic relationships with national and regional commercial health plans, Medicare stakeholders, Medicaid programs, Medicare Administrative Contractors, integrated delivery networks, and other payer decision makers. Working across Market Access, Clinical and Medical Affairs, Health Economics and Outcomes Research, Regulatory, Legal, Finance, Marketing, and Sales, the Director translates clinical evidence, economic value, and customer insight into actionable account strategies and favorable access outcomes.
OPPORTUNITIES YOU WILL HAVE IN THIS ROLE
Key Responsibilities
Payer Strategy and Account Leadership
- Develop and execute payer account plans aligned with portfolio, launch, and lifecycle priorities, including objectives, stakeholder maps, engagement sequencing, evidence needs, risks, and measurable outcomes.
- Own strategic relationships with assigned national and regional commercial payers, Medicare and Medicaid stakeholders, health-plan medical directors, policy teams, pharmacy or benefit managers where relevant, and payer-affiliated integrated delivery networks.
- Lead payer engagements that address medical policy, utilization-management criteria, coding, reimbursement, payment adequacy, network considerations, and patient-access barriers.
- Negotiate and implement appropriate payer agreements or value-based arrangements in partnership with Legal, Finance, Compliance, and senior leadership, when applicable.
Coverage, Coding, Payment, and Policy
- Monitor and analyze payer policies, coverage criteria, claims experience, reimbursement pathways, policy-review cycles, and emerging federal and state developments that may affect access.
- Identify barriers to adoption and create focused action plans to obtain favorable, evidence-based coverage and appropriate payment for eligible patients and providers.
- Partner with reimbursement, coding, and health-policy experts on Medicare, commercial, Medicaid, facility, and physician payment strategies.
- Support engagement with relevant government, payer, and assessment bodies, including health technology assessment organizations when applicable.
Evidence and Value Communication
- Provide payer insights that shape clinical-development, real-world evidence, health-economics, outcomes-research, and evidence-generation priorities.
- Collaborate on payer value propositions, evidence dossiers, payer presentations, budget-impact and cost-effectiveness materials, coding and billing resources, and other access tools.
- Organize and facilitate payer advisory boards, medical-director discussions, executive account meetings, and clinical-expert engagements.
- Communicate field intelligence, policy trends, competitive access developments, and account risks to cross-functional leadership with clear recommendations.
Cross-Functional Execution and Leadership
- Partner with Medical Affairs, Clinical Affairs, Regulatory, HEOR, Marketing, Sales, Patient Access, Legal, Compliance, and Finance to execute integrated market-access plans.
- Coordinate launch-readiness and lifecycle initiatives against defined milestones, dependencies, budgets, and performance measures.
- Train internal stakeholders on payer policy, reimbursement pathways, value messaging, and compliant payer engagement.
- May lead employees, consultants, or project teams, including coaching, performance guidance, resource planning, and budget oversight.
Measures of Success
- Progress toward favorable or improved payer policies and reduction of inappropriate access barriers.
- Quality, reach, and strategic value of payer relationships and executive engagements.
- Completion and effectiveness of account plans, launch milestones, and evidence or value deliverables.
- Timely communication of payer insights and effective cross-functional execution.
- Compliance with company policies, quality-system requirements, and approved engagement practices.
QUALITY SYSTEM RESPONSIBILITIES
- Complete required training and competency confirmations within established timelines.
- Document product- and therapy-related field reports and provide follow-up information in accordance with applicable procedures and timelines.
- Comply with quality-system, privacy, legal, regulatory, and compliance requirements, and recommend opportunities for continuous improvement.
- Ensure payer interactions, evidence communications, contracting discussions, and external materials follow approved company processes.
Core Competencies
- Strategic payer engagement and account planning
- Coverage, coding, and payment expertise
- Evidence-based value communication
- Executive presence and influence
- Negotiation and stakeholder management
- Cross-functional leadership
- Analytical problem solving
- Execution, prioritization, and business judgment
Required Qualifications
- Bachelor's degree in business, health sciences, public health, economics, engineering, or a related field.
- 10 or more years of experience in medical technology, healthcare, payer relations, market access, reimbursement, managed care, or a related field.
- At least 3 years of direct experience influencing payer coverage, medical policy, reimbursement, contracting, or access strategy.
- Demonstrated knowledge of U.S. commercial insurance, Medicare, Medicaid, medical policy, coding, coverage, and payment pathways for medical technologies.
- Experience developing strategic account plans and leading complex engagements with health-plan medical directors, policy leaders, or senior payer executives.
- Strong executive communication, presentation, negotiation, consultative, analytical, and project-management skills.
- Ability to work independently, exercise sound business judgment, and lead broad cross-functional initiatives in a matrixed environment.
- Ability to travel up to 75%, including occasional overnight travel.
Preferred Qualifications
- Master's degree in business administration, public health, health policy, health economics, health services research, or a related discipline.
- 12 or more years of relevant experience, including medical-device experience and established relationships with national or regional payer decision makers.
- Experience supporting one or more product launches and building access pathways for novel procedures, implants, diagnostics, or digital health technologies.
- Experience with real-world evidence, HEOR, claims analytics, budget-impact models, value-based care, or payer contracting.
- Working knowledge of CMS payment systems, Medicare Administrative Contractors, state Medicaid programs, integrated delivery networks, and health technology assessment processes.
#LI-Remote