Associate Director

3 weeks ago

Tampa, United States GCB Services LLC Full time
Job DescriptionJob Description

Purpose

Responsible for ensuring patient access to the Client's oncology products within assigned geographical areas via supporting HCPs and Office staff in navigating therapy Prior Authorizations (PAs), Medical Necessity documentation, and therapy PA denial appeals. Develop collaborative working partnerships with HCPs and Office Staff, to support Patient access to therapies. This position works with medical practice therapy decision-makers, practice clinical administrators, key office support staff, and clinical pharmacists to assist with Health Plan/PBM therapy approval requests. This position is also responsible for collaboration with the ClientsPatient Support Services Team, Market Access Field Teams, Clients AGMs, SCs, and MSLs to execute reimbursement and access programs to reduce access and affordability hurdles for patients on oncology products. The span of coverage will be GA, AL, FL, and a portion of SC. Travel up to 50% within the territory. The candidate must be domiciled within the territory.

Key Tasks and Responsibilities

  • Extensive disease state/therapy space experience (specific to Clients Programs/Therapies)
  • Govt, National, and local Commercial Payer experience, State Medicaid, and Managed Plans
  • Experience in educating and supporting the Prior Authorization process, appeals, and denials
  • Covermymeds portal access experience a plus
  • Proactive education - Access Services by The client
  • Stay current with local MAC policies and procedures
  • Excellent verbal and written communication skills as well as prior experience educating providers
  • Collaborating across multiple stakeholders
  • Proactive Problem-solving, defusing, and resolving escalations, consistent and timely follow-up
  • Proven experience in flexibility and adaptability Territory Management
  • Ability to engage and navigate HCPs in various settings including hospitals, private practice, large multi-specialty practices, IDNs, IDN out-patient clinics, and other facilities
  • Initiative-taking business acumen to identify and resolve HCP/Office Staff issues/challenges with Payer/PBM therapy approvals
  • New Product / Indications launch experience
  • Must have a valid driver's license with a safe driving record/ MVR
  • Specialty Pharmacy Experience
  • Experience educating and/or supporting pharmacies.

Required Qualifications

  • Bachelor's Degree or a minimum of 5 years of healthcare-related reimbursement experience
  • 2 + years of Field Reimbursement experience
  • In-depth understanding of Payer/PBM therapy approval requirements (Prior Authorization, Medical Necessity, Denial Appeals, Formulary coverage, and payment for oncology therapies across all sites of care (hospital, clinic, integrated delivery network) and ability to apply this knowledge to address individual customer concerns
  • Broad knowledge of Medicare, managed care, third-party payers, and Medicaid
  • Demonstrated excellence in meeting and exceeding customer expectations, especially in demanding situations
  • Ability to effectively address customer concerns in a timely fashion and by working collaboratively with external and internal stakeholders
  • An elevated level of sophistication/people skills is needed to interact with practice clinical decision-makers, office support staff, clinical pharmacists, and office managers
  • Must demonstrate a comprehensive knowledge of customer relations, therapy formulary coverage, utilization management, and the ability to interpret complex information
  • Must possess the leadership ability to effectively organize, communicate, and collaborate with HCPs, Key Practice Staff, and clients external and internal team members
  • Exceptional knowledge of Healthcare Management
  • Pharmaceutical Manufacturers federal, state, and local compliance requirements
  • Area Reimbursement Managers will cover multiple regions, thus significant overnight travel, up to 50%
  • Must have a valid driver's license with a safe driving record/ MVR.

Preferred Qualifications

  • 2 + years Oncology Field Reimbursement Experience
  • Experience in oncology and working with key oncology stakeholders.

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