Executive Director - Payer Strategy and Engagement, Tumor HI Program

POSITION SUMMARY

• Provide critical leadership and above-country market access strategies including core disease models, value stories, global pricing, economic modeling, and input into Clinical Development programs.
• Work closely with Medical Affairs colleagues, Organized customers and Distribution providers to identify real-world and patient quality of life data capture / evidence value solutions and publication opportunities.
• Monitors healthcare legislative trends, understands healthcare policies, assesses implications of policies, and develops reimbursement strategies that address barriers to provider and patient access.
• Understands total cost of care and all aspects of reimbursement (coverage, coding, and payment) for outpatient and inpatient settings across multiple payer segments.
• Support the formulation of a clear and compelling disease and product value propositions through the creation of payer engagement (AMCP Dossier, Value and Economic Prop.), and provider / patient reimbursement support tools.
• Monitor the competition to understand how the evolving market will impact current and future market access strategies.
• Identify and develop pricing recommendations, coding and reimbursement strategies for current and pipeline assets that will support future Pricing and Reimbursement decisions in the US and other key Ex-US markets.
• Engage to support the advancement of ICD-10 CM coding initiatives, and product-specific HCPCS coding application.
• Identify product market access risks and opportunities, incorporate them into pipeline product strategies and reflect them in identified Target Product Profiles.
• Identify pricing and reimbursement analogues to support value and access decisions.
• Create payer materials for branded and unbranded disease awareness campaigns.
• Support the identification, creation of defensible, performance driven, quality / outcomes or risked based product / portfolio contract, or rebate opportunities.
• Manage agency relationships and contracts to deliver tools/tactics/resources, and ensure on time delivery, that is aligned with the departmental budget.
• Provide subject matter expertise to the broader organization, including competitive and product coverage access intelligence, healthcare reform, landscape trends, and pull-through initiatives.  This includes cross-functional support of corp. training initiatives, content, tools and presentation development in partnership with Training and Cross-Departmental leaders.
• Represent Rezolute at Key Industry Conferences (e.g. AMCP, PCMA, ISPOR, Asembia, etc.).
• Ensure that all activities and interactions are carried out with the highest ethical and professional standards, and that all work is accomplished with quality and in accordance with Rezolute values.
• Manage/recruit in-house or contracted payer account team to educate key payers using PIE (Payer Information Exchange) before approval and PVP (Payer Value Proposal) after the approval
• Educate payers on the label and influence them to develop policies based on the label and/or clinical trial exclusion criteria
• Resolve rejection/prior authorization issues by closely working with the payers and patients support services team and hub in a timely manner

QUALIFICATIONS

Experience with rare/orphan drugs is required. Therapeutic area experience is a plus.
Product launch experience is required, and company start-up experience is preferred.
Familiarity with current legal and regulatory landscape pertinent to the pharmaceutical/biotechnology industry.
Strong analytical capabilities, with working knowledge of government pricing practices (calculations methodologies, HTA, healthcare programs, and supporting regulations), and trade systems and processes.
Demonstrated flexibility to adapt to a changing environment, implement creative solutions to complex problems, and ability to function in a project leadership role.
Ability to develop and maintain strong internal and external relationships, including direct collaboration with vendors and other third parties.
Superior interpersonal, oral and written communication, and presentation skills, with great attention to detail.
Leads with strong business acumen and a compliance mindset.
Passionate about patients and building a new commercial organization.
Advanced Microsoft Excel, Word and PowerPoint skills. 

PREFERRED EXPERIENCE, EDUCATION, CERTIFICATIONS, LICENSES:

Minimum Bachelor’s degree required; sciences or business preferred, advanced degree related medical, health economics, health outcomes research, or epidemiology (MS, MBA, MPH, MD/DO, PhD, PharmD) preferred.
Minimum of 10 years of overall industry experience in biotech or pharmaceuticals (i.e. market access and reimbursement, sales, sales management, marketing, training, sales operations, or healthcare / life sciences consulting).
5 years of US market access and reimbursement experience required, with Global and/or international experience preferred.  This includes, HTA, US Payer, Patient and Provider access, HEOR, and medical benefit reimbursement coding expertise.