National Payer Relations Manager
72% Flex- Remote from:United States
National Payer Relations Manager
Offer summary
Qualifications: Bachelor's degree in related field, 5+ years in medical device industry, 4+ years in reimbursement or market access role, Knowledge of coding, coverage, reimbursement processes, Understanding of Medicaid programs and reimbursement policy.
Key responsabilities:
- Develop and execute payer strategy
- Build relationships with decision-makers
- Recommend new growth opportunities
- Collaborate with cross-functional teams
- Support sales and advocacy initiatives
Job description
Your missionsLife Unlimited. At Smith+Nephew we design and manufacture technology that takes the limits off living.
The National Payer Relations Manager (NPRM) is pivotal in supporting the US Market Access Department's mission to ensure patient access to best-in-class technologies and products for Advanced Wound Management, including Grafix, Oasis, and PICO. The NPRM will focus on government payers (such as Medicare, Medicaid, and Veterans Affairs) and commercial payers (including United, Anthem, Cigna, Aetna, Blue Cross, etc.) in executing company goals. The NPRM is the primary contact and expert driving payer strategy to secure coverage and reimbursement for Smith & Nephew Advanced Wound Management products. The NPRM role drives patient access to vital medical therapies while building a positive reputation for the company within the payer community, which spans over 100 million lives.
Responsibilities of the NPRM include but are not limited to, developing and maintaining relationships with key decision-makers within the regional Medicare Administrative Contractor (MAC), commercial payers, state health associations, and other relevant organizations. The NPRM influences policy decisions, local coverage determinations (LCDs), fee schedules, product coverage, utilization management, and reimbursement payment decisions. Additionally, the NPRM is tasked with developing and implementing payer coverage and reimbursement strategies tailored to secure appropriate access, coverage, and reimbursement for the Smith & Nephew wound care product portfolio across assigned government and commercial payer segments.
Collaboration with the US Market Access Team, Clinical and Medical Affairs, VP of Healthcare Strategy, Healthcare Systems colleagues, and Sales leadership is essential to ensure strategic alignment and successful execution of payer initiatives. The NPRM must possess strong leadership skills and project management capabilities, working collaboratively with cross-functional leads to analyze payer gaps and devise effective strategies. Acting as a business consultant, the NPRM communicates a compelling value proposition specific to the needs of both internal and external stakeholders. This role requires a highly independent and proactive individual capable of driving results in a dynamic healthcare landscape."
What will you be doing?
Develop and maintain strong relationships with decision-makers both government and commercial payers
Analyze, develop and execute on payer strategy and initiatives remove access barriers, new and expanded coverage for product portfolio
Proactively identify and recommend new payer growth opportunities for the product portfolio
Work collaboratively with Sales, Field Reimbursement, and Hotline on payer coverage pull-through
Liaison with cross -functional leads to build customer-facing collateral to support field sales education, and payer advocacy initiatives
What will you need to be successful?
Bachelors degree in business, health sciences, management, healthcare administration, or related field
Licenses/ Certifications: Certified Professional Coders is a plus
Minimum of 5 years in the medical device or biotechnology industry
Minimum of 4 years of experience in a reimbursement or market access role
Extensive knowledge of coding, coverage, and reimbursement
Solid understanding of government (e.g., national/local coverage determinations), and commercial payer coverage process
Proven understanding of reimbursement methodologies by site of care (e.g., hospital inpatient, outpatient, ASC, physician’s office, etc.)
Understanding of State Medicaid programs and the policy development process
Prior experience growing medical product coverage with payers preferred.
Prior experience in wound care preferred
Familiarity with MDMA, AdvaMed, and other associations preferred
Travel Requirements: Up to 65%
You Unlimited.
We believe in creating the greatest good for society. Our strongest investments are in our people and the patients we serve.
Inclusion, Diversity and Equity: Committed to Welcoming, Celebrating and Thriving on Diversity, Learn more about Employee Inclusion Groups on our website (https://www.smith-nephew.com/)
Your Future: 401k Matching Program, 401k Plus Program, Discounted Stock Options, Tuition Reimbursement
Work/Life Balance: Flexible Personal/Vacation Time Off, Paid Holidays, Flex Holidays, Paid Community Service Day
Your Wellbeing: Medical, Dental, Vision, Health Savings Account (Employer Contribution of $500+ annually), Employee Assistance Program, Parental Leave, Fertility and Adoption Assistance Program
Flexibility: Hybrid Work Model (For most professional roles)
Training: Hands-On, Team-Customized, Mentorship
Extra Perks: Discounts on fitness clubs, travel and more!
The anticipated compensation range for this position is $115,000.00 - $130,000.00 USD annually and the compensation offered will depend on the candidate’s qualifications. You may also be entitled to receive bonus and benefits, which may include medical, dental, and vision coverage, 401k, tuition reimbursement, medical leave programs, and a variety of wellness offerings.
Smith & Nephew follows the Pay Transparency and non-discrimination provisions described by the Colorado Department of Labor and Employment (CDLE)
#LI-REMOTE
#LI-RS3.
Smith+Nephew provides equal employment opportunities to applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability.
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Required profile
- Strong leadership and project management
- Proactive, independent, results-driven mindset
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