Head of Reimbursement and Health Policy

23 Dec, 2020


Head of Reimbursement and Health Policy

Thrive Earlier Detection
Washington, DC
At Thrive, we are motivated to change the way people think about cancer. We challenge the status quo and are willing to think differently. Our curiosity drives us. There are countless questions related to cancer, and we flourish by finding solutions. We know what we do is important, and we take our work seriously. We also have fun. We do our work with vibrant energy, and we laugh out loud at the little things. This is How We Thrive.
The Role
The Head of Reimbursement and Health Policy is responsible for directing the overall Medicare/Medicaid reimbursement roadmap and health policy initiatives for the organization. This person will be responsible for proactively translating organizational objectives into an advocacy and engagement strategy that considers all appropriate stakeholders, and for anticipating and responding to changes in the reimbursement and regulatory environments.

Major Responsibilities

      • Reimbursement
      • Work closely with the SVP of Policy to create and implement a comprehensive reimbursement strategy.
      • Establish appropriate value-based reimbursement strategy with CMS and payer community including, Medicaid.
      • Develop and implement a strategy for review and successful inclusion in guidelines (e.g., USPSTF and NCCN)
      • Set strategy and direction for educating and influencing key payer decision-makers. Direct development of dossiers for reimbursement and coverage purposes of each product
      • Cultivate a professional line of communication and maintain relationships with key thought leaders in the Medicare/Mediciaid payer market and promote appropriate utilization of the Company’s products to key decision-makers, thought leaders and advocacy groups.
      • Collaborate with the relevant commercial and clinical groups within the Company to maximize coverage and reimbursement for all the Company’s current and future products
      • Coordinate triage of reimbursement challenges to leadership for guidance and support
      • Health Policy
    • Work closely w SVP Policy to develop, implement, and lead a strategic approach to engage business leadership with the goal of identifying and prioritizing proactive legislative and regulatory (rule making) initiatives that support key business objectives and drive business development opportunities. Develop appropriate policy positions with business leadership to ensure consistency of messaging and coordination with the business.
    • Articulate, advance, and implement a strategic and tactical approach and advocacy agenda in support of the organization’s priorities and efforts.
    • Identify and advance business opportunities (also minimizing potential business threats), keep business segment leadership informed of key public policy activities and developments within Congress, the Administration and key agencies
    • Pursue opportunities to engage third-party stakeholders and policy decision-makers to extend thought leadership and policy objectives
    • Identify opportunities to lead public dialogues to advance the Company’s interests
    • Monitor the political and regulatory landscape for threats and opportunities to the organization and effectively communicate this intelligence to business leadership. This will include ongoing analysis of such developments that includes describing the potential impact of the action(s) on the business, working out various scenarios, and recommending appropriate positions and responses.
    • Engage in advocacy initiatives with industry members, trade associations, lobbyists, and other companies to proactively ensure that the organization’s positions are understood and reflected in the development of industry positions. This also may require taking leadership positions within associations through various task forces, sub-committees, and working groups, primarily focused on issues the Company determines important from time to time.
    • Support and facilitate opportunities for internal team to interact with key policy-makers, officials, association partners, thought leaders, and other stakeholders.
    • Identify opportunities and develop mechanisms for mobilizing grassroots lobbying campaigns
    • Develop and implement a political compliance program to educate impacted employees and directors to help ensure compliance with applicable federal, state and local lobbying and ethics laws/regulations, including pay-to-play requirements

Requirements and Qualifications

    • Bachelors degree required; advanced degree (ie. JD, MBA, etc.) strongly preferred
    • 10+ years of industry experience in Federal government/regulatory affairs
    • Strategic and political thinker a must
    • Prior experience working in a legislative policy position or regulatory department for a trade association, appropriate Federal agency, or biotechnology company required.
    • Successful experience with USPSTF, health economic and outcomes research (HEOR) studies strongly preferred
    • Ability to develop and maintain strong internal and external relationships while enhancing the company’s policy and legislative positions
    • Strong communication and diplomatic skills with the ability to give presentations to a wide spectrum of audiences, both internally and externally
    • Outstanding interpersonal skills, with the ability to establish rapport and credibility with key individuals and to build and maintain a broad network of relationships in the preventive health services field
    • Strong commitment to integrity and teamwork with proven ability to work collaboratively across teams, departmental and industry boundaries
    • Successful track record of being a leader in policy setting environments such as in-house at a corporation, a trade association, or in a relevant Department or Agency
    • Superior oral and written communication skills, with the ability to persuasively and succinctly communicate complex concepts and programs at the highest levels of business and government
Thrive Earlier Detection is an equal opportunity employer and will not discriminate against any employee or applicant on the basis of age, color, disability, gender, national origin, race, religion, sexual orientation, veteran status, or any classification protected by federal, state, or local law.
TO ALL AGENCIES:Please, no phone calls or emails to any employee of Thrive about our openings. All resumes submitted by search firms/employment agencies to any employee at Thrive via email, the internet or in any form and/or method will be deemed the sole property of Thrive, unless such search firms/employment agencies were engaged by Thrive for this position and a valid agreement with Thrive is in place. In the event a candidate who was submitted outside of the Thrive agency engagement process is hired, no fee or payment of any kind will be paid.
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Job posted: 2020-12-23