The Senior Manager supports Payer Access & Reimbursement activities as a member of a cross-functional team, oriented to Medical Affairs (MA) activities related to medical access, evidence generation, value proposition creation, and coverage in policy, all of which impact the reimbursement of Quest's portfolio of tests. This individual proactively brings expertise in the reimbursement of laboratory medicine to build and execute key strategic initiatives and decision points. The Senior Manager is instrumental in the coordination of activities related to external engagement with health plans, specialty societies, coalitions, and others where required to enhance coverage and reimbursement or improve the reputation of Quest Diagnostics with the professional and payer communities. This individual must possess strong leadership, problem solving, and presentation capabilities to help facilitate the decision-making process as it relates to stakeholders' interests, while mitigating risk for the organization.This is a Remote opportunityAssist in the development of MA strategies aligned with business needs and the evolving external health system environment (private and government payers, regulatory environment) for optimal access, utilization, and reimbursement of Quest products.Identify and harness opportunities to improve coverage and reimbursement (C/R) for assigned Payer Access category in all phases (e.g., idea to market, lifecycle management). Execute and/or inform strategies based on root causes of denials.Evaluate coverage landscape and focus on clinical utility.Leverage and coordinate internal/external stakeholders and resources to identify and address C/R opportunities. Collaborate with cross-functional teams (e.g., other MA teams, Clinical Franchises, Health Plans, Billing, Coding/Compliance/Legal) to develop Payer Access strategies to optimally support business needs.In conjunction with Payer Access leadership and cross-functional teams, support efforts to develop medical value proposition for marketed tests and pipeline assets. Collaborate with other internal Quest teams as needs arise.Execute project responsibilities for some aspects of the evidence-based medical documentation development and communication.Identify and track progress of Annual Operating Plan (AOP) activities including appropriate metrics and reporting platforms.Participate in the drafting and revision of written materials (e.g., policy response letters, slide decks) for external distribution.Maintain knowledge of all assigned disease states, products, relevant changes in medical and reimbursement policies, and changes in payer procedures. Ensure incorporation into the short and long-term business plans.Educate the Clinical Franchise, Commercial, Medical, Legal/Compliance, and Research and Development organizations about the evolving healthcare payor environment, the key external stakeholders, and their evidence needs. Lead and contribute to establishing processes that support successful development and communication of reimbursement-based value proposition for Quest Diagnostics offerings. Support and lead the strategic development and participation in health policy efforts.Understand and participate in the emerging dialogue on clinical evidence needed to support/expand coverage and reimbursement for diagnostic tests in assigned Payer Access category.Performs other functions of the MA department as needed.Required Work Experience: 8 years' experience between the following:Laboratory medicine (e.g., cytotechnologist, microbiologist, molecular variant scientist, laboratory genetic counselor)Payer policy/claims procedures (e.g., medical/reimbursement policy, billing and coding)Clinical practicePreferred Work Experience: 10 years' experience between at least two of the following:Laboratory medicine (e.g., cytotechnologist, microbiologist, molecular variant scientist, laboratory genetic counselor)Payer policy/claims procedures (e.g., medical/reimbursement policy, billing and coding)Clinical practicePhysical and Mental Requirements: Ability to execute concurrent projects Adaptable to abrupt changes in projects based on external influences/internal business needsStrategic mindsetCommunicationKnowledge: In-depth knowledge of medical terminology.Demonstrated understanding of the healthcare, health insurance, Medicare/Medicaid, and regulatory environments. Skills: Strong time managementStrong written and oral communication skillsCollaborative approach in cross-functional team settingsIntermediate-advanced skills in using Microsoft Word, Excel, and PowerPoint software packages. Education: Bachelor's degree in a relevant discipline (e.g., life sciences, health/public policy) requiredAdvanced degree (e.g., Master's or doctorate) in a relevant discipline (e.g., life sciences, health/public policy, genetic counseling) preferredTravel: Upto 25%Quest Diagnostics is an equal employment opportunity employer. Our policy is to recruit, hire and promote qualified individuals without regard to race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation, gender identity, or any other status protected by state or local law. Quest Diagnostics observes minimum age requirements established by federal, state and/or local laws, and will ask an applicant for verification when deemed necessary.
