Senior Manager, Upstream Reimbursement Strategy
Core
Architect long-range reimbursement and market access strategy for the U.S. product portfolio, serving as the primary strategic interface between clinical development, HEOR, and health policy stakeholders.
Role type
Senior Manager, Upstream Reimbursement Strategy
Builds
Strategic reimbursement roadmaps, evidence generation plans, CPT/HCPCS code pathways, and value dossiers for pipeline assets.
Domain
Healthcare / Medical Devices / Market Access / Health Economics
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Reimbursement strategy design, Evidence generation strategy, CPT/HCPCS code pathway design, CMS payment policy analysis, Global evidence coordination, Health economic modeling, Claims data interpretation, Competitive intelligence analysis, Payer advisory board leadership, Target product profile development
Preferred skills
Advanced degree (MPH, MBA, PhD, PharmD), Healthcare data platform familiarity, HEOR model familiarity
Technologies
CMS OPPS/PFS/ASC systems, AMA CPT Editorial Panel processes, RUC, HCPCS workgroups, NICE, ICER
Responsibilities
Design and oversee health economic and outcomes research studies; Lead strategy for new code applications and descriptor modifications; Conduct ongoing analysis of CMS payment policy and submit comment letters; Coordinate U.S. evidence needs with global HEOR and OUS markets; Develop strategic reimbursement roadmaps and core value dossiers; Lead early payer advisory boards and simulated HTA exercises; Monitor competitor reimbursement strategies and translate insights into recommendations.
Seniority
Senior Manager, strategic planning & cross-functional leadership
