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Engage with senior commercial leaders in a broad range of areas outside of market access such as sales, medical, regulatory, operations, finance, supply chain, manufacturing, pharmacovigilance, external affairs, and other functions.
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The Market Access & Regional Reimbursement Manager 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.
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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.
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Minimum of 4 years of experience in a reimbursement or market access role. 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.
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Understanding of State Medicaid programs and the policy development process. Analyze, develop and execute on payer strategy and initiatives remove access barriers, new and expanded coverage for product portfolio.
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Effectively communicate and appropriately collaborate with the Market Access team to ensure strategic alignment and effective implementation of the clinical strategy for National and Regional Managed Care accounts, covering all books of business (e.g., Commercial, Managed Medicaid, Fee-for-Service, Medicare, PBMs, and Exchange Plans.
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Advanced degree in medical/biosciences (i.e., PharmD, MD, PhD.) AND minimum 3 to 5 years related experience (field liaison responsible for market access , worked for managed care organization, corporate or field HEOR, etc.
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Collaborating closely with the Medical Team and the Market Access team, the MVL engages in scientific exchange and enters strategic discussions with health care decision makers as they relate to medical/clinical and health economic and outcome research (HEOR) data with payers, policy makers, and other decision makers and influencers.
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Current market access/HEOR experience in the therapeutic areas of interest to Karuna preferred. Extensive knowledge of the Medicaid/Medicare environment, payor market commercial insurance, as well as the pharmaceutical corporate environment.
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Provide input and strategic direction to the development of market access -specific customer facing resources. bms.com/ ( eeo-accessibility to access our complete Equal Employment Opportunity statement.
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Works closely with US Policy and Access Strategy to develop internal analysis, education, and generate materials on relevant health policy topics, including but limited to sources of insurance (e.g., Medicare, Medicaid, commercial), drug supply chain and intermediaries (e.g., GPOs, PBMs), healthcare providers (e.g., varying settings of care and practice types; 340B entities), and drug pricing concepts (e.g., WAC, ASP, best price.
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Establishing and maintaining appropriate relationships with BMS business partners in Sales, Market Access, Trade, and Marketing. Working across US Market Access Teams to assist with resolution of product coverage and access issues.
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Complete understanding of all MCO/Medicare/Medicaid reimbursement issues and their impact on business performance; identify potential obstacles and lease with Market access to resolve effectively.
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Understanding of State Medicaid programs and the policy development processPrior experience growing medical product coverage with payers preferred. 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.
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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.
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