Field Reimbursement Manager (FRM) - Great Lakes
Otsuka America Pharmaceutical Inc., Hagatna, Gu, United States
Position Summary
The Field Reimbursement Manager (FRM) serves as the subject‑matter expert on reimbursement, access, and coverage issues for our products, primarily focusing on Nephrology and Rare Disease. This role operates as a crucial liaison between healthcare providers (HCPs), internal teams, and external stakeholders to facilitate appropriate patient access to our products.
Key Responsibilities
Educate HCPs and their staff on matters related to access, coverage, reimbursement processes, claims submissions, and coding requirements
Analyze payer criteria and provide product access expertise to healthcare offices
Coordinate with Hubs on individual patient cases, including patient support services and enrollment
Collaborate with Field Sales, Specialty Pharmacy Accounts, and other matrix partners
Manage daily field‑based activities, spending 60-70% of time interacting with key stakeholders across various care sites
Execute collaborative territory plans through partnerships with internal and external stakeholders
Review and educate offices on payer policies, including prior authorization requirements
Provide feedback to internal teams on local payer trends and access issues
Assist in resolving patient‑specific coverage challenges when requested by healthcare providers
Skills and Abilities
Excellent verbal and written communication skills
Strong interpersonal and consultative abilities
Self‑directed with outstanding organizational skills
Ability to build and maintain strong relationships with internal and external customers
Proficient in delivering training and presentations
Qualifications Required:
Bachelor's degree
5+ years of pharmaceutical industry experience, with focus on payer policy and reimbursement
3+ years of experience in benefit verifications, prior‑authorization requirements, or equivalent experience in patient access, billing, and coding in rare disease
Preferred:
Strong knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, especially Medicare Part D
Experience in "Buy and Bill" reimbursement environment
Nephrology experience strongly preferred
Comprehensive understanding of US healthcare system payer billing practices
Proficiency in MS Office suite
Travel Requirements
Ability to travel up to 60-70% domestically
Valid driver's license required
Competencies
Accountability for Results - Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change.
Strategic Thinking & Problem Solving - Make decisions considering the long‑term impact to customers, patients, employees, and the business.
Patient & Customer Centricity - Maintain an ongoing focus on the needs of our customers and/or key stakeholders.
Impactful Communication - Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka.
Respectful Collaboration - Seek and value others’ perspectives and strive for diverse partnerships to enhance work toward common goals.
Empowered Development - Play an active role in professional development as a business imperative.
Company Benefits
Comprehensive medical coverage
Dental coverage
Vision coverage
Prescription drug coverage
Company provided basic life insurance
Accidental death & dismemberment coverage
Short‑term and long‑term disability insurance
Tuition reimbursement
Student loan assistance
Generous 401(k) match
Flexible time off
Paid holidays
Paid leave programs
For more information about our benefits: https://www.otsuka-us.com/careers-join-otsuka.
Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will be given consideration for employment without regard to race, color, sex, gender identity or gender expression, sexual orientation, age, disability, religion, national origin, veteran status, marital status, or any other legally protected characteristic.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation, if you are unable or limited in your ability to apply to this job opening as a result of your disability. You can request reasonable accommodations by contacting Accommodation Request (EEAccommodations@otsuka-us.com) .
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Key Responsibilities
Educate HCPs and their staff on matters related to access, coverage, reimbursement processes, claims submissions, and coding requirements
Analyze payer criteria and provide product access expertise to healthcare offices
Coordinate with Hubs on individual patient cases, including patient support services and enrollment
Collaborate with Field Sales, Specialty Pharmacy Accounts, and other matrix partners
Manage daily field‑based activities, spending 60-70% of time interacting with key stakeholders across various care sites
Execute collaborative territory plans through partnerships with internal and external stakeholders
Review and educate offices on payer policies, including prior authorization requirements
Provide feedback to internal teams on local payer trends and access issues
Assist in resolving patient‑specific coverage challenges when requested by healthcare providers
Skills and Abilities
Excellent verbal and written communication skills
Strong interpersonal and consultative abilities
Self‑directed with outstanding organizational skills
Ability to build and maintain strong relationships with internal and external customers
Proficient in delivering training and presentations
Qualifications Required:
Bachelor's degree
5+ years of pharmaceutical industry experience, with focus on payer policy and reimbursement
3+ years of experience in benefit verifications, prior‑authorization requirements, or equivalent experience in patient access, billing, and coding in rare disease
Preferred:
Strong knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, especially Medicare Part D
Experience in "Buy and Bill" reimbursement environment
Nephrology experience strongly preferred
Comprehensive understanding of US healthcare system payer billing practices
Proficiency in MS Office suite
Travel Requirements
Ability to travel up to 60-70% domestically
Valid driver's license required
Competencies
Accountability for Results - Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change.
Strategic Thinking & Problem Solving - Make decisions considering the long‑term impact to customers, patients, employees, and the business.
Patient & Customer Centricity - Maintain an ongoing focus on the needs of our customers and/or key stakeholders.
Impactful Communication - Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka.
Respectful Collaboration - Seek and value others’ perspectives and strive for diverse partnerships to enhance work toward common goals.
Empowered Development - Play an active role in professional development as a business imperative.
Company Benefits
Comprehensive medical coverage
Dental coverage
Vision coverage
Prescription drug coverage
Company provided basic life insurance
Accidental death & dismemberment coverage
Short‑term and long‑term disability insurance
Tuition reimbursement
Student loan assistance
Generous 401(k) match
Flexible time off
Paid holidays
Paid leave programs
For more information about our benefits: https://www.otsuka-us.com/careers-join-otsuka.
Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will be given consideration for employment without regard to race, color, sex, gender identity or gender expression, sexual orientation, age, disability, religion, national origin, veteran status, marital status, or any other legally protected characteristic.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation, if you are unable or limited in your ability to apply to this job opening as a result of your disability. You can request reasonable accommodations by contacting Accommodation Request (EEAccommodations@otsuka-us.com) .
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