Regional Manager, Managed Care
Location Marlborough, MA, US
Department Name Managed Care
Shift Information
Summary of Duties and Responsibilities
The Regional Manager of Managed Care with drive reimbursement strategies and leverage data to negotiate favorabl medical policies with government and commercial payers within a region.
Essential Duties & Responsibilities
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Designs and drives reimbursement and communication strategies to proactively leverage data in order to negotiate favorable medical policies with government (Medicare, Medicaid) and commercial payers on a regional level
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Writes, maintains and implements strategies to accomplish goals for individual payers within assigned region.
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Additionally maintains primary responsibility for at least one national payer as regards to appropriate policy and payment, communicating strategies to team members and field sales as appropriate.
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Responsible for coverage and reimbursement for all Hologic business lines within assigned region, as determined based on the needs of the business.
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Petitions medical directors and payers for positive coverage/policy update for Hologic products based on new product data or new clinical studies on existing products.
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Field travel with sales team members and account visits:
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Sales travel to understand the business and educate on reimbursement issues.
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Account visits to assist with payer issues encompassing coverage and reimbursement.
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Interfaces with key individuals within the payer community (CEO, CFO, Medical Director etc) on a national and regional level (government as well as commercial payers) and with key stakeholders in the medical community to guide implementation of externally focused strategies and programs.
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Cultivates business partnership with account decision makers to achieve preference over competitors.
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Collaborates and strategizes with sales mangers and representatives within region as it relates to reimbursement and coverage policies.
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Develops and maintains relationships with key thought leaders within the private sector and payer communities to effectively assist Hologic with regional and national payer strategies.
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Works with Advocacy and Managed Care department and business units as needed to effectively influence positive public policy and reimbursement decisions.
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Provides education and consultation to managed care department on reimbursement trends and issues with recommendations for action.
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Assists with the development of tools to be utilized by the managed care team as well as field sales teams.
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Serves as a scientific and clinical support resource for products. This may include direct scientific and medical support during interactions with physicians, insurance companies, and professional societies.
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Provides input and teamwork in the development of strategies to secure optimal policy and reimbursement for Hologic products and the procedures they entail.
Qualifications
· Excel at interpreting and assessing the reimbursement environment and developing effective strategies to optimize reimbursement and coverage for all business units.
· Understand technology assessment processes for the payer environment.
· Encompass strong knowledge of all aspects of payer systems, including risk management systems and provider contracting.
· Exemplify ability to think strategically, set and manage priorities, manage multiple projects, and allocate and reallocate resources as required.
· Demonstrate effective leadership skills and is able to manage a team of diverse people equitably.
· Establish clear direction for projects, including goals and objectives, and organize work in a well-planned manner.
· Communicate clearly with numerous teams, such as each business unit’s sales teams, and advocacy/managed care team.
· Serve as an acknowledged expert on company’s products and related competitive products in all areas relevant to internal and external customers: clinical, scientific, technical and health economics.
o Strength in usingresourcefulnessto identify data and information which will increase product knowledge, drive strategic decisions, and bring increased value to customers (internal and external)
· Gather intelligence and report on the reimbursement environment and strategies for Hologic’s products as well as that of the competition.
· Possess excellent oral and written communication skills as well as presentation skills and have the ability to effectively advocate Hologic’s position to different stakeholders.
· Proficient with computer skills (word, excel and power point).
· Drive for outstanding results incorporating sense of urgency when pursuing goals
· Inspire trust and integrity in all internal and external communications, build confidence and trust of others and acts consistently with values, ethics and respect. Understand the need for political savvy.
· Work collaboratively across functional areas to achieve common goals and is approachable to all individuals regardless of their role.
o Capable of quickly adapting and successfully interacting with multiple types of teams and levels both internally and externally, as the needs of the business change or evolve.
Education
Bachelor's degree.
Experience
Five to eight years diagnostic, surgical or pharmaceutical sales and/or marketing experience (direct executive level managed care marketing in devices is preferred).
Specialized Knowledge
· Must be capable of keeping up with constantly evolving and very fragmented health insurance infrastructure.
· Handles rejection well.
· Demonstrates commitment and persistence.
· Understands financial implications in a business model and is able to quickly make adjustments.
· Skilled at multitasking and adjusting to a changing environment with high demands.
· Highly self-motivated.
· Maintains focus on department and/or individual objectives despite the sometimes lengthy nature of the goal.
· Ability to move easily between micro and macro views of a given project or goal, depending on the circumstances.
o Communicating appropriately dependent upon the audience.
· Ability to balance individual goals and team goals in order to support all business needs/objectives.
· Must be capable of resourceful functioning in a very autonomous role.
