Aetna Utilization Management Jobs (NOW HIRING)

The Opportunity

The Director of National Accounts (DNA) will serve as Amylyx's primary interface with U.S. payers, supporting appropriate coverage and patient access planning in preparation for a potential future commercial launch of our lead product candidate.

This individual contributor role is responsible for developing and executing Amylyx's national and regional payer engagement strategies to support evidence-based coverage discussions and patient access planning. This role serves as the primary interface with national and regional payers, PBMs, Medicare, Medicaid, and other government customers, while also partnering cross-functionally with Market Access Field Teams, HEOR, Medical Affairs, Patient Services, Sales, and Distribution teams in accordance with company policies and applicable laws and regulations.

We anticipate the start date of the Director National Accounts to be in September 2026.

Territory & Account Alignment

Multiple Director of National Account positions may be filled and will be assigned to accounts based on business needs, customer alignment, and candidate experience and may evolve over time.

While account assignments may change as the organization grows, current planning includes alignment to three broad territories.   This role is currently planned to cover ME, NH, VT, MA, RI, CT, NY, PA, NJ, DE, MD, DC, VA, NC, SC, GA, FL, PR:

East Region Accounts (Examples may include):

• CVS Health - Aetna/CVS Caremark/Zinc
• Elevance Health - Anthem/CarelonRx
• Assigned national and regional payer accounts
• Assigned State Medicaid Fee-for-Service Programs
• Assigned VA/DoD/TRICARE responsibilities

Key Responsibilities

National Payer Strategy & Leadership

• Develop and execute national and regional payer strategy across commercial, Medicare Part D/MA-PD, Managed Medicaid, FFS Medicaid, VA/Tricare/DoD, and PBMs to support appropriate coverage and access objectives.
• Anticipate payer evidence needs; partner with HEOR and medical teams to inform value evidence and access strategy ahead of potential launches, consistent with approved materials and internal review processes.
• Provide strategic input on contracting considerations, distribution networks, coverage considerations, and pharmacy-benefit dynamics.
• Analyze policy trends, competitive intelligence, and legislative developments that affect rare disease access; translate insights into strategy.

Executive-Level Payer Engagement

• Build and maintain compliant, professional relationships with pharmacy directors, medical directors, policy leaders, and other payer stakeholders involved in evidence review and access decision-making.
• Support compliant executive-level discussions regarding coverage policy considerations, prior authorization concepts, utilization management frameworks, and formulary review processes.
• Develop customized, data-driven account plans aligned with Amylyx access objectives.
• Deliver approved clinical, economic, and real-world evidence presentations, as appropriate.

Coverage Policy Development & Access Tools

• Develop payer coverage and utilization-management strategy recommendations that support compliant pre- and post-launch access planning.
• Develop and deliver compliant, approved payer-facing resources to support evidence-based payer review processes.

Launch Readiness & Pipeline Support

• Engage with payers, as appropriate, to understand evidence expectations, anticipate potential access considerations, and inform compliant mitigation planning.
• Ensure alignment between payer strategy and field execution in collaboration with Market Access Field Teams and field-based Regional Scientific Directors.
• Support pre-approval information exchange (PIE) planning and execution in accordance with company policies and applicable regulations.
• Ensure all payer engagement and access-related activities are conducted in accordance with approved product labeling (post-launch), applicable laws and regulations, and consistent with internal review processes.
• Contribute to launch readiness planning, account prioritization, and market access strategy development.

Cross-Functional Collaboration & Leadership

• Partner with Field Access Managers to translate payer policy into compliant provider-level access support.
• Collaborate with Medical Affairs to support compliant pre- and post-launch scientific engagements with payer customers.
• Work with Patient Services and distribution partners to support reimbursement confidence and efficient, compliant patient access processes.

Market Intelligence & Thought Leadership

• Represent Amylyx at key industry forums including AMCP, PCMA, Asembia.
• Monitor and advise internal stakeholders on payer dynamics and market access strategy.
• Provide ongoing insights regarding pharmacy benefit trends, specialty pharmacy evolution, Medicaid policy changes, and government healthcare programs.

Required Qualifications

• Bachelor's degree required; advanced degree (PharmD, MBA, MPH) strongly preferred.
• 10+ years within the pharmaceutical or biotech industry.
• 5+ years managing national and regional payers and PBM accounts with expertise in commercial, Medicare Part D, Medicaid, VA/Tricare/DoD, and IDN environments.
• Proven experience supporting launches and/or access planning for rare disease or specialty therapies within pharmacy-benefit channels.
• Deep understanding of PBM business models, specialty pharmacy networks, utilization management, reimbursement pathways, and payer decision-making processes.
• Demonstrated success building senior-level payer relationships and supporting evidence-based coverage discussions.
• Demonstrated ability to build and manage relationships with national and regional payers, PBMs, state Medicaid programs, VA/Tricare/DoD, and specialty pharmacies.
• Experience presenting clinical and economic evidence to payer leaders.
• Experience supporting payer policy discussions and developing compliant payer-facing resources.
• Strong strategic thinking, negotiation skills, and ability to collaborate across organizations.
• Strong analytical, project management, communication, and relationship-building skills.
• Ability to travel 25-50%. This position requires significant driving by the employee and other modes of travel / transportation including (but not limited to) airline travel and public transit.

Key Competencies

• Strategic Market Access Leadership
• National Payer & PBM Relationship Management
• Rare Disease Reimbursement Expertise
• Coverage Policy & Utilization Management Strategy
• Cross-Functional Influence
• Launch Strategy & Execution
• Value Communication & Health Economics
• Problem Solving & Negotiation Excellence
• Entrepreneurial Mindset and Ability to Thrive in Ambiguity

Work Location and Conditions

• At Amylyx, we proudly support remote work opportunities within the United States. However, due to business considerations related to health insurance coverage and state tax regulations, we are unable to hire employees who reside and/or work in certain states. Currently, we are not considering applicants from Alaska, Arizona, Hawaii, Michigan and Tennessee. Preference may be given to candidates residing within or near the geographic region they support.
• You will be expected to travel to our corporate location in Cambridge, MA several times a year and attend other company-related events as necessary and requested.
• You must have access to work in setting which enables meeting all requirements of the role (including privacy, reliable internet access, phone, ability to video conference, etc.) at your remote location.