- Identify and create a relationship with the payer (health plan, behavioral health plan, employer plan) decision maker for coverage.
- Understand the criteria to win coverage for each payer.
- Develop and assist with value based contracting criteria when required.
- Determine when criteria are excessive and develop alternatives for payer consideration.
- Communicate payer needs clearly to the Myriad organization.
- Represent Myriad at the medical professional organization level, including key payer professional meetings.
- Collaborate with internal guideline team to win inclusion into external guidelines.
- Advise internal scientific product teams with clinical trial design outcomes specifically for payers.
- Create and execute publication strategy.
- Deliver clinical, scientific, and health economic data to payer decision makers that are tailored to their specific needs.
- Support Revenue Cycle Department in payer discussions surrounding utilization management and the impact to patient access and clinical care.
- Identify non-compliant payers.
- Advise and assist regulatory/legal team with prosecution strategies
- Meets minimum education and experience requirements:
- Medical degree (MD or DO) and at least 3 years of clinical experience.
- At least 2 years of coverage policy criteria experience in the health insurance industry
- Previous experience in precision medicine or diagnostic industry preferred
- Essential Skills and Experience
- Ability to listen for discernment and present to executives at stakeholder organizations in written or verbal form. Creating consensus is a key outcome of this capability.
- Ability to work in cross-functional teams as a collaborator or leader.
- Demonstrated experience in clinical utility and outcomes based research.
- Strategic thinking capability, with demonstrated ability to identify new opportunities for growth.
- Executive leadership skills that have successfully led the ideation, the plan development, and the execution of a major product/service.
- Extensive knowledge of the US healthcare ecosystem, payer landscape, and payer evidence requirements
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VP Payer Strategy - Salt Lake City, United States - Myriad Genetics & Laboratories
Description
The primary outcome for this VP Payer Strategy is improved patient access and reimbursement for Myriad's products:The VP Payer Strategy/Medical Director's responsibilities involve three key functions:
Listening and understanding to the payer's needs.
Qualifications:
Lifting Requirements - sedentary work or exerting up to 10 pounds of force occasionally. Physical Requirements - stationary positioning, moving, communicating, and observing. Use of equipment and tools that are necessary to perform essential functions of the job.
EEO
We recognize that our people are our strength and the diverse talents they bring to our global workforce are directly linked to our success.
In hiring and all other employment decisions, we prohibit discrimination and harassment on the basis of any protected characteristic, including race, religion, color, national origin, gender, sexual orientation, gender identity, gender expression, age, marital or veteran status, pregnancy or disability, or any other basis protected under applicable law.
In accordance with applicable law, we make reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as any mental health or physical disability needs.
