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United States » Manager, Health Economics & Reimbursement

Manager, Health Economics & Reimbursement

Irvine, CA, US.

Position Summary:  Manage and support the implementation of reimbursement and health economics/market access strategies related to coverage and payment policies for the US.

Key Responsibilities:

  • Establish detailed understanding and ability to navigate payers’ (e.g., central Medicare, Medicare contractors, and private insurers) coverage and payment processes, including ongoing monitoring of policy issues.
  • Contribute to the development of market access (coding, coverage, payment) strategies and resources that enhance patient access to THV therapies.
  • Support internal and external stakeholders (e.g., health economics field team, cardiovascular teams within the hospitals) while leveraging knowledge gained through direct interactions and relationships, in order to provide relevant input to coverage and payment conversations.
  • Monitor changes in the external environment (health policy and regulatory) and advise senior leadership on threats and opportunities with suggested action plans.
  • Collaborate with internal Government Affairs, Healthcare Policy, and Reimbursement and Health Economics teams to assist with the management of advocacy relationships with regional KOLs and societies, trade party associations and other key third parties to influence outcomes of critical policy issues.
  • Support the development and management of tools that provide education to internal and external stakeholders on relevant policy and reimbursement related issues.
  • Incidental – Other health economics and reimbursement special projects, as assigned

Basic Qualifications:

  • Bachelor’s Degree or Equivalent in in a life science, health economics, health policy, or related field
  • Minimum 8 years of related experience
  • Experience in health economics and/or outcomes research and reimbursement is preferred

Preferred Qualifications:

  • Ability to balance strategic thinking with intricate planning and strong tactical execution.
  • Proven track record of leading thought, plans and actions that result in desired business impact
  • Proven successful project management skills
  • Proven expertise in Microsoft Office Suite and related tools and systems
  • Excellent documentation and communication skills and interpersonal relationship skills including negotiating and relationship management skills with ability to drive achievement of objectives
  • Extensive knowledge of own area within the organization while contributing to the development of new concepts, techniques, and standards
  • Extensive understanding of key public and private payer policy infrastructure, medical device payment methodologies, coding and coverage basics, and/or health policy trends.
  • Understanding of medical device industry, especially with functional responsibility in reimbursement planning, program implementation, and health economics and outcomes research.
  • Experience working with external stakeholders and customers (e.g., vendors, payers, hospitals, physicians, etc.), as well as internal cross-functional teams and business units.
  • Strong problem-solving, organizational, analytical and critical thinking skills
  • Strong business acumen, analytical skills and experience working with various internal business partners (especially Sales, Marketing, Medical Affairs, Clinical, Regulatory, Legal, and Government Affairs staff) to provide insight into key market access issues.
  • Ability to adapt to rapidly changing environment
  • Strict attention to detail
  • Ability to interact professionally with all organizational levels and proactively escalate issues to appropriate levels of management in the organization
  • Ability to manage competing priorities in a fast paced environment
  • Represent leadership on sections of projects within a specific area interfacing with team members and other managers and may include suppliers, vendors and/or customers
  • May participate and present at meetings

Adhere to all company rules and requirements (e.g., pandemic protocols, Environmental Health & Safety rules) and take adequate control measures in preventing injuries to themselves and others as well as to the protection of environment and prevention of pollution under their span of influence/control

Aligning our overall business objectives with performance, we offer competitive salaries, performance-based incentives, and a wide variety of benefits programs to address the diverse individual needs of our employees and their families.

For California, the base pay range for this position is $111,000 to $158,000 (highly experienced).

The pay for the successful candidate will depend on various factors (e.g., qualifications, education, prior experience).

Edwards is an Equal Opportunity/Affirmative Action employer including protected Veterans and individuals with disabilities.

COVID Vaccination Requirement

Edwards is committed to complying with the requirements and guidance from our government authorities and to protecting our vulnerable patients and the healthcare providers who are treating them around the world. As such, all Healthcare Interacting positions require COVID-19 vaccination, which includes anyone who directly interfaces with patients and those who interact with healthcare providers as part of their role. If hired, as a condition of employment, you will be required to submit proof that you have been fully vaccinated for COVID-19, unless you request and are granted a medical or religious accommodation for exemption from the vaccination requirement. This vaccination requirement does not apply in countries where it is prohibited by law to impose vaccination. In countries where vaccines are less available, or other requirements exist, we may institute alternate measures that optimize patient safety and healthcare provider safety, which may include regular COVID testing or specific masking requirements.

This job is posted by Edwards Lifesciences.


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