Associate Director, Access & Reimbursement RLT - San Diego, CA - Remote

Key Responsibilities:

• Interact with large, complex accounts to support patient access within their aligned therapeutic area product(s), proactively provide face-to-face education on programs to providers and staff in order to support integration of those products into office processes and workflows.
• Address customer questions for issues related to NPC policies on therapeutic area products ordering, payment, inventorying, and product returns & replacement in offices.
• Work with key members of therapeutic area offices (e.g., executives, providers, administrators, billing and coding staff, claims departments, revenue cycle managers) in order to appropriately support patient access to products.

• Ability to analyze problems and offer solutions. Understand specifics and support questions associated with patient reimbursement and coordinate on reimbursement issues with third party payers at the provider-level. Analyze account reimbursement issues & opportunities (as needed). Identifies trends at a local, regional and national level and partner with purpose internally and externally to support patient pull-through.

• Supports pull through on local coverage decisions to enable meaningful patient access within the system. Proactively communicate policy changes or issues that could potentially affect other departments.
• Accountable for informing customers on NVS-sponsored patient support programs to enable patients starting and staying on therapy (i.e., Co-pay).
• Maintain expertise in regional and local access landscape, anticipating changes in the healthcare landscape, and act as their aligned therapeutic area product(s) reimbursement expert (as needed).
• Collaborate with aligned cross-functional associates within NPC (see above) to share insights on customer needs and barriers for their aligned therapeutic area product(s) related to access and reimbursement; Interface with Patient Support Center (hub) and Access & Reimbursement Managers on important matters related to patient case management, including tracking cases, issue resolution, reimbursement support, and appropriate office staff education.
• Maintain a deep understanding of NPC policies and requirements and perform all responsibilities with integrity and in a manner consistent with company guidance and prescribed Values and Behaviors. Handle Patient Identifiable Information (PII) appropriately (understand and ensure compliance with HIPPA and other privacy laws and regulations and internal Company compliance guidelines).

Buy and Bill Specific

• Assess access situation within the assigned geography and develop appropriate Plan of Action (POA).  Communicate POA to appropriate personnel.
• Responsible for establishing preferred acquisition pathways. Educate on and support buy-and-bill end-to-end processes, workflows, and facility pull-through in complex accounts, including scenarios of centralized and decentralized acquisition, and use of alternative channels such as white bagging, clear bagging, brown bagging, and alternate site of care for administration.
• Educates relevant stakeholders on logistics related to ordering, payment, inventory, and product returns & replacement.
• Analyze reimbursement issues & opportunities, anticipating changes in the healthcare landscape, and act as the designated reimbursement expert for offices and field teams.
• Accountable for engagement with non-prescribers, for example pharmacy, system leadership, financial counselors, office administrators, revenue cycle managers, etc.

Radioligand Therapies Specific

The ADAR will be a critical partner to the Novartis Patient Support (NPS) customer engagement team on supply capacity, site procurement eligibility, as well as a customer facing resource for communications on orders and logistics.

• Understand RLT key priorities in core disease areas, financial goals, and site initiatives to influence overall account and regional business strategies.
• Assess and understand site and/or other appropriate organizations’ level of readiness for procurement of nuclear medicines and billing to facilitate orders for products and so that they can engage and educate on procurement systems and processes, access, and reimbursement. Be able to understand where gaps in procurement exist and work with Cross-Functional partners to resolve.
• Partner with the customer engagement teams to assist the communication and facilitation of procurement and logistics with both the site and the local field teams. (e.g., procurement, logistics processes and timing) as well as patient-specific support (benefit verification, PA and appeals and copay programs)
• Major accountabilities apply to therapy, diagnostic and theragnostic treatment centers.

What You’ll Bring to the Role:

Education: Bachelor’s degree required; Business and/or biological science education preferred. Advanced degree preferred.

Essential Requirements:

• 5+ Years of experience in pharmaceuticals / biotech industry focused in Patient Services, Market Access, Sales, and/or account management. With 2 of those years being in a Patient Services practice support role for a specialty product(s).
• Experience working with highly complex practices and/or health systems to establish access and acquisition pathways.
• Strategic account management experience using a proactive approach to anticipate access hurdles impacting accounts and patient access.
• Deep expertise and experience integrating manufacturer-sponsored patient support programs.
• Experience with specialty products acquired through Specialty Pharmacy networks.
• Knowledge of reimbursement pathways (specialty pharmacy, buy-and-bill, retail)
• Possess a strong understanding of Commercial payers, Medicare plans and state Medicaid in geographic region.
• Must live within assigned territory; Ability to travel and cover geography, at least 50% travel required, based on geography and territory / targeting make up.

Desirable Requirements:

• Experience leading and delivering presentations to C-level account executives.
• Strong ability to work cross functionally with such functions as Field Sales, Marketing, Market Access, Public Affairs, State & Government Affairs, Trade, Specialty Pharmacy Account Management, and applicable third-party affiliates.
• Expertise in therapeutic area practice dynamics and common reimbursement and product program support-related needs. Such as Oncology, Prostate Cancer or Nuclear Medicines
• Strong capabilities in the areas of customer focus, collaboration, business acumen, communication, and presentation skills.

Novartis Compensation and Benefit Summary: The pay range for this position at commencement of employment is expected to be between $174,400 and $261,600/year; however, while salary ranges are effective from 1/1/24 through 12/31/24, fluctuations in the job market may necessitate adjustments to pay ranges during this period.  Further, final pay determinations will depend on various factors, including, but not limited to geographical location, experience level, knowledge, skills and abilities. The total compensation package for this position may also include other elements, including a sign-on bonus, restricted stock units, and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment. If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

Field roles with a dedicated training period only:

The individual hired for this role will be required to successfully complete certain initial training, including home study, in eight (8) or fewer hours per day and forty (40) or fewer hours per week.

Driving is an essential function of this role, meaning it is fundamental to the purpose of this job and cannot be eliminated. Because driving is an essential function of the role, you must have a fully valid and unrestricted driver’s license to be qualified for this role. The company provides reasonable accommodations for otherwise qualified individuals with medical restrictions if an accommodation can be provided without eliminating the essential function of driving.

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