Director / Senior Director, Project Management

Caris Life Sciences; Comunidad Valenciana; A distancia; USD 180.000 - 195.000; Jornada completa

Descripción de la vacante

An established industry player is seeking a Director of Medicaid Accounts to lead coverage initiatives and maximize reimbursement for innovative healthcare solutions. This role involves strategic contract negotiations, collaboration with cross-functional teams, and building alliances with advocacy groups. The successful candidate will leverage their extensive knowledge of Medicaid and reimbursement programs to enhance patient access and ensure compliance with policies. If you're passionate about making a difference in healthcare and have a proven track record in Medicaid contracting, this opportunity is perfect for you.

Servicios

Inclusive medical, dental, and vision coverage

Health Savings Account

Flexible Spending Account

Paid time off

401k match

Employee Assistance Program

Tuition Assistance

Formación

• 5+ years of experience in Medicaid contracting and coverage.
• Extensive knowledge of reimbursement programs in healthcare sectors.

Responsabilidades

• Manage complex contract negotiations with Medicaid plans.
• Develop strategies for acceptance of testing into medical policies.

Conocimientos

Contract Negotiation

Medicaid Coverage Knowledge

Reimbursement Programs

Presentation Skills

Interpersonal Skills

Project Management

Educación

Bachelor’s Degree in Business or Related Field

Herramientas

Microsoft Excel

Microsoft PowerPoint

Descripción del empleo

Caris Life Sciences Director - Medicaid Accounts in Remote, Spain Position Summary

The Director of Medicaid Accounts is responsible for coverage initiatives with Medicaid Fee for Service and Managed Medicaid plans. Responsible for obtaining positive coverage policies, contracting, completing provider enrollments, and maximizing reimbursement while minimizing access barriers for patients and providers. Travel is required at requested times, outside of incumbent’s region, to provide national support. Ability to manage complex contracting documents, ensure business needs are met within the agreements, and make recommendations on legal review and pull-through initiatives coordinated with marketing and sales teams.

This position is field based.

Job Responsibilities

1. Complete state Medicaid enrollments and work to gain coverage through FFS Medicaid, including policy and coding coverage.
2. Contract to be an in-network provider with Managed Medicaid plans. Manage complex contract negotiations and work with cross-functional departments to ensure contract performance and pull-through.
3. Develop and implement strategies that lead to successful acceptance of Caris Life Sciences testing into medical policy guidelines and add codes to state fee schedules.
4. Stay up to date on trends in the managed care market and develop strategies with senior management to address changes and maintain acceptable reimbursement rates.
5. Build alliances with patient advocacy groups, professional societies, and key opinion leaders to support coverage and payment policies.
6. Prepare responses to Request for Proposals (RFP).
7. Assist field representatives with reimbursement challenges.
8. Attend conferences and physician meetings.
9. Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
10. Support and comply with company policies and procedures.
11. Collaborate with teams including Operations, Account Management, Analytics, Billing, and Sales to ensure contract performance and identify opportunities/challenges.
12. Actively pursue opportunities and assess market trends to enhance the company's market position.
13. Ensure compliance with operating policies, procedures, and standards.
14. Supervise and train team members as needed.
15. Represent the organization well; support its mission, goals, and objectives; participate as a “team player”. Set an example of high conduct for employees and others.
16. Reporting : Maintain and distribute the monthly Medicaid Payor Reports.

Required Qualifications

• Bachelor’s degree in business, marketing, science, or related field.
• 5+ years of experience in contracting and coverage with Medicaid and managed Medicaid organizations, medical group contracting, sales, or related health plan contracting/coverage experience.
• Extensive knowledge of reimbursement programs in pharma, lab, biotech, and/or device sectors.
• Proficiency in Microsoft Excel and PowerPoint.
• Experience in revenue cycle and fee schedule management.
• Possession of a valid driver's license.
• Ability to perform essential duties with or without accommodation.
• Authorization to work in the U.S. without sponsorship.
• Strong presentation skills and confidence in communicating with all organizational levels.
• Ability to develop value propositions and influence medical policy.
• Ability to present complex data persuasively to diverse audiences.
• Outstanding influencing, interpersonal, and networking skills for relationship building.

Preferred Qualifications

• Proven success with state Medicaid reimbursements at desired ASP.
• Experience in reimbursement contracting, especially in molecular diagnostics or life sciences.
• Ability to work independently, research, and stay current on healthcare trends.
• Understanding of the molecular diagnostic testing market.
• Experience in managing complex negotiations with multiple decision-makers.
• Strong problem-solving, project, and program management skills.
• Effective time management, expense reporting, and delegation skills.
• Effective presentation skills for diverse audiences.
• Existing relationships with insurance companies and payer organizations.
• Project management skills are a plus.

Physical Demands

• Ability to lift up to 10 pounds for about 10% of the workday.
• Work seated approximately 80% of the time, standing about 20%.
• Work in front of a computer screen for about 80% of the time.
• Comply with PPE requirements as applicable.

Training

All job-specific, safety, and compliance training are assigned based on job functions.

Other

• Ability to travel approximately 30% within the region and occasionally outside for meetings.

Annual Hiring Range

$180,000 - $195,000

Actual offer may vary based on location, experience, education, and skills. The pay ratio will be finalized at the offer stage.

Description of Benefits

• Inclusive medical, dental, and vision coverage.
• Health Savings Account, Flexible Spending Account.
• Paid time off, 401k match, LTD, STD, and voluntary benefits.
• Employee Assistance Program, Pet Insurance, Legal Assistance, Tuition Assistance.

Conditions of Employment

Successful completion of pre-employment checks including background, drug, credit (if applicable), and references.

This description reflects essential functions but does not restrict management’s right to assign duties.

Caris Life Sciences is an equal opportunity employer. All qualified applicants will receive consideration regardless of race, religion, color, national origin, gender, gender identity, sexual orientation, age, veteran status, disability, or other protected status.

We are committed to advancing molecular science and artificial intelligence to improve cancer patient outcomes.