About the role:

This Senior Manager, Payer Relations & Value-Based Offerings is responsible for supporting the senior level strategic relationships with national and regional United States (U.S.) health plans, including integrated delivery network (IDN)-owned health plans. The Senior Manager is responsible for securing market access and coverage for the targeted portfolio of products with payers and provider organizations. Develops and executes business plans for payer stakeholders, within defined territory, to positively advocate and remove barriers to access and to ensure coverage and reimbursement for procedures and devices. Payer stakeholders include commercial private and public payers (Health Plans, Medicaid, Medicare), selected complex provider systems and other market influencers. Partners and collaborates with internal and external stakeholders to understand the barriers to access to Endobariatric technologies. This position will report to the Director, HEMA, Endoscopy.

Responsibilities will include:

• Managing and leading the development and implementation of national and regional payer activities for the Company’s Endoscopy’s Endobariatrics franchise working with corporate and divisional staff and key internal and external stakeholders.
• Actively participating in the development and execution of practical strategies to secure optimal coverage for products and procedures.
• Executing strategies and tactics for reimbursement and access within targeted local and regional plans for key technologies.
• Leading implementation of tactical planning activities required to achieve strategic coverage objectives including payer team tools, provider access tools, sales team messaging, etc.
• Identifying key health coverage needs for platform products, working with divisional counterparts and health economics and outcomes research colleagues to determine actions required.
• Assessing coverage opportunities and challenges facing the division’s emerging technologies and commercially marketed products.
• Collaborating with the leader of the National Payer Relations and Corporate Accounts team to leverage partnership discussions whenever possible to support coverage activities and to share contacts and best practices.
• Monitoring policy developments that impact the coverage of the Company products.

Required qualifications:

• A bachelor’s degree (B.A. or B.S.) is required; an advanced degree is preferred.
• A minimum of 5 years of experience working in coverage determination and utilization management within a commercial payer organization.
• Established a network of Medical Directors and health insurance plans (AHIP, NAMCP, etc.)
• Experience with Medicare and Medicaid coverage strategy.
• Deep knowledge of healthcare, managed care strategy, pricing, and the medical reimbursement environment is required.
• Prior strategic account management responsibilities or equivalent relationship development or consulting experience with one of the following: payers, government agencies, IDNs, and Accountable Care Organizations (ACOs).
• Proven ability to successfully interact with the C-suite.
• Platform presentation skills that make this individual a desired speaker at industry events in front of large groups.
• Proven track record of influence management within a matrix environment.
• Proven ability to successfully manage complexity, solve problems, and build strong relationships.
• Ability to work well independently as well as collaboratively; self-motivated and disciplined to meet deadlines in the context of competing priorities and projects; lead and work effectively with cross-functional teams.
• Ability to maintain and effectively deal with highly confidential matters.
• Proven ability to work with commercial organizations, ensuring timely engagement and customer support of internal and external customers.
• Computer literacy (Microsoft Office Suite), including a high level of competency in Excel.

Preferred qualifications:

• Experience with metabolic and bariatric diseases.
• Highly organized with the ability to effectively manage multiple priorities in a fast-paced environment.
• Must be able to travel (75% travel) as dictated by business needs.
• Strong written and oral communication skills.
• Well-developed strategic and analytical skills.
• Ability to model and live the Company’s corporate values.