Director, Payer Relations
Johnson & Johnson, Santa Clara, CA, United States
Job Function: Market Access
Job Sub Function: Health Economics Market Access
Job Category: Professional
All Job Posting Locations: Arizona (Any City), California (Any City), Illinois (Any City), Maryland (Any City), Massachusetts (Any City), Minnesota (Any City), New York (Any City), Pennsylvania (Any City), Santa Clara, California, United States of America, Texas (Any City)
Remote work options may be considered on a case‑by‑case basis and if approved by the Company.
Position Overview The Director of Payer Relations is responsible for developing and managing strategic relationships with national and regional health plans and other third‑party payers. This role ensures that Shockwave Medical’s products are positioned favorably with payers, networks, and reimbursement structures to maximize patient access and organizational revenue. The individual will also partner cross‑functionally with members of the sales, marketing, and clinical affairs teams to inform the long‑term evidence strategy required to obtain and maintain reimbursement in U.S. markets.
Key Responsibilities
Lead the development and execution of national and regional payer coverage and reimbursement strategies, including clinical data and publication requirements, health economics, and general value proposition models, to ensure successful payer negotiations, commercial viability, and improved patient access to covered IVL indications.
Engage with third‑party evidence review organizations to ensure up‑to‑date reviews of Shockwave clinical data and provide education and materials in support of positive conclusions from clinical literature.
Develop and maintain strong relationships with target payers and build a working knowledge of their key processes including medical policy, utilization review, health outcomes, risk management, provider contracting, and claims processing.
Develop relationships with Advisory Committee members and payer Medical Directors for public and private payers to support changes that reflect local medical practices.
Influence policy development such as new Local Coverage Determinations (LCDs) and engage with various coverage advisory groups to enhance patient access.
Effectively leverage and communicate published literature and other evidence to payers, demonstrating IVL value that positively influences coverage policy development.
Monitor payer coverage policies, track review periods, and analyze data on medical review, prior authorization, and claims payment trends to inform payer strategy, tactics, and team priorities.
Collaborate with Field Reimbursement Managers as needed for ongoing strategy execution.
Support Clinical Education with lead local physician advocates to influence payer coverage and medical review policies.
Improve effectiveness and focus of industry alliances, as needed, that support Medicare and commercial payer policy and patient access.
Provide internal and external voice‑of‑customer (VOC) feedback to guide strategy development.
Develop programs to train Sales Representatives and key economic customers on reimbursement issues.
Perform other duties as assigned.
Qualifications
Bachelor’s degree in public policy, health economics, or life sciences required; Master’s degree preferred.
7–10 years of healthcare coding, coverage, and reimbursement experience with medical devices; vascular or coronary experience is a plus.
Experience with complex reimbursement areas including Medicare and commercial payer policies and processes.
Demonstrated success in developing coverage for emerging technologies and influencing payer policies.
Strong understanding of clinical and economic data, coding, coverage, and payment issues.
Expertise in reimbursement principles across various healthcare settings (physician offices, hospitals, ambulatory surgery centers).
Willingness to travel 25–50% as required.
Excellent written and verbal communication skills.
Proficiency in Microsoft PowerPoint, Excel, and Word.
Preferred Skills
Agility Jumps, Commercial Awareness, Competitive Landscape Analysis, Cross‑Functional Collaboration, Customer Intelligence, Global Market, Go‑to‑Market Strategies, Health Economics, Health Intelligence, Market Knowledge, Market Opportunity Assessment, Mentorship, Organizing, Pricing Strategies, Regulatory Compliance, Strategic Change, Tactical Planning, Technical Credibility
Pay Transparency The anticipated base pay range for this position is $157,000.00 – $271,400.00.
Johnson & Johnson is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, protected veteran status or other characteristics protected by federal, state or local law. We actively seek qualified candidates who are protected veterans and individuals with disabilities as defined under VEVRAA and Section 503 of the Rehabilitation Act.
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Remote work options may be considered on a case‑by‑case basis and if approved by the Company.
Position Overview The Director of Payer Relations is responsible for developing and managing strategic relationships with national and regional health plans and other third‑party payers. This role ensures that Shockwave Medical’s products are positioned favorably with payers, networks, and reimbursement structures to maximize patient access and organizational revenue. The individual will also partner cross‑functionally with members of the sales, marketing, and clinical affairs teams to inform the long‑term evidence strategy required to obtain and maintain reimbursement in U.S. markets.
Key Responsibilities
Lead the development and execution of national and regional payer coverage and reimbursement strategies, including clinical data and publication requirements, health economics, and general value proposition models, to ensure successful payer negotiations, commercial viability, and improved patient access to covered IVL indications.
Engage with third‑party evidence review organizations to ensure up‑to‑date reviews of Shockwave clinical data and provide education and materials in support of positive conclusions from clinical literature.
Develop and maintain strong relationships with target payers and build a working knowledge of their key processes including medical policy, utilization review, health outcomes, risk management, provider contracting, and claims processing.
Develop relationships with Advisory Committee members and payer Medical Directors for public and private payers to support changes that reflect local medical practices.
Influence policy development such as new Local Coverage Determinations (LCDs) and engage with various coverage advisory groups to enhance patient access.
Effectively leverage and communicate published literature and other evidence to payers, demonstrating IVL value that positively influences coverage policy development.
Monitor payer coverage policies, track review periods, and analyze data on medical review, prior authorization, and claims payment trends to inform payer strategy, tactics, and team priorities.
Collaborate with Field Reimbursement Managers as needed for ongoing strategy execution.
Support Clinical Education with lead local physician advocates to influence payer coverage and medical review policies.
Improve effectiveness and focus of industry alliances, as needed, that support Medicare and commercial payer policy and patient access.
Provide internal and external voice‑of‑customer (VOC) feedback to guide strategy development.
Develop programs to train Sales Representatives and key economic customers on reimbursement issues.
Perform other duties as assigned.
Qualifications
Bachelor’s degree in public policy, health economics, or life sciences required; Master’s degree preferred.
7–10 years of healthcare coding, coverage, and reimbursement experience with medical devices; vascular or coronary experience is a plus.
Experience with complex reimbursement areas including Medicare and commercial payer policies and processes.
Demonstrated success in developing coverage for emerging technologies and influencing payer policies.
Strong understanding of clinical and economic data, coding, coverage, and payment issues.
Expertise in reimbursement principles across various healthcare settings (physician offices, hospitals, ambulatory surgery centers).
Willingness to travel 25–50% as required.
Excellent written and verbal communication skills.
Proficiency in Microsoft PowerPoint, Excel, and Word.
Preferred Skills
Agility Jumps, Commercial Awareness, Competitive Landscape Analysis, Cross‑Functional Collaboration, Customer Intelligence, Global Market, Go‑to‑Market Strategies, Health Economics, Health Intelligence, Market Knowledge, Market Opportunity Assessment, Mentorship, Organizing, Pricing Strategies, Regulatory Compliance, Strategic Change, Tactical Planning, Technical Credibility
Pay Transparency The anticipated base pay range for this position is $157,000.00 – $271,400.00.
Johnson & Johnson is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, protected veteran status or other characteristics protected by federal, state or local law. We actively seek qualified candidates who are protected veterans and individuals with disabilities as defined under VEVRAA and Section 503 of the Rehabilitation Act.
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