Remote Prior Authorization Rn Jobs in Temecula, CA

REIMBURSEMENT LIAISON DIRECTOR 

The Reimbursement Liaison Director's primary role is to facilitate the growth of Glaukos products by way of leading and coaching field-based reimbursement team members.  Work cross-functionally with the internal Director of Sales, Director of Corporate Accounts and Private Equity, Payer Relations team and Payer Strategy team to ensure a unified platform. 

What will you do?

The Reimbursement Liaison Director provides strategic leadership and expert guidance to a team of field-based Reimbursement Liaisons. This role's focus is on facilitating patient access to Glaukos' sight-saving technologies through comprehensive coding, coverage and payment education and support for healthcare providers (HCPs). The Reimbursement Liaison Director collaborates cross-functionally with numerous departments including Sales, Corporate Accounts, Practice Integration, Patient Services/HUB, Payer Relations and Payer Strategy to ensure a unified and effective approach to patient access.

Responsibilities include: 

• Leads and mentors by establishing clear objectives and performance metrics, including providing tactical guidance on complex reimbursement issues and ensuring the team has the necessary resources to meet customer needs.
• Establish team SOPs, KPIs, Development opportunities and oversee a structured performance management framework, including regular evaluations and feedback sessions.
• Identify training needs and coordinate development opportunities to enhance team performance and expertise in reimbursement practices while fostering a culture of continuous improvement and accountability. 
• Ensure all reimbursement activities comply with legal, regulatory, and corporate guidelines, mitigating risks associated with non-compliance
• Establish, monitor, report customer engagement, outcomes, and RL SOPs metrics.
• Lead Performance Reviews, including ride-alongs/co-travel to provide expertise and coaching: in account management, specialty pharmacy, patient assistance programs, buy & bill acquisition, policy reviews, claim reviews and processing.  
• Proactively scanning/monitoring, identifying, and reporting reimbursement trends with strong personal ownership for identifying and communicating solutions via cross-functional collaboration (e.g., HCPs receiving notification of policy changes, claim denials, underpayments, etc.) and engages payer team appropriately when patient access may be jeopardized. 
• Maintain expertise in regional and national payer landscapes, specifically, proper clinical requirements, reimbursement policy, utilization management criteria, prior authorization processes and appeal requirements. 
• Ability to travel adequately to cover territory, as well as overnight travel (~50%) and attendance at scheduled training and meetings. 

How Will You Get Here?

Required

• Bachelor's Degree in Science, Business, or Marketing required. Advanced Degree (MPH, MBA ,MHA) preferred. 
• Minimum of 10 years "direct" reimbursement/healthcare policy experience.
• Minimum of 3-5+ years previous field-based reimbursement team management experience, preferably with products within prelaunch or early launch phases. 
• Experience with launching and supporting drug/ device combination products. 
• Demonstrated subject matter expertise in US Payer/insurance coverage and marketplace, including Medicare, Medicare Advantage, VA/Tri-Care, Commercial and Medicaid.
• Cross-functional experience and strong interpersonal skills within a team environment, with experience leading by influence towards business result. 
• Demonstrated excellent proven written and verbal communication skills with ability to speak to all levels of the organization as well as understand and use data in communications.

Preferred

• Previous ophthalmology product/services in ASC/MD office experience.
• Cross-functional team experience in multiple drug/device combination departments, such as business development, strategy, marketing, sales and/or corporate development roles within a medical device or pharmaceutical company.
• Experience working in a highly matrixed environment that incorporates compliance with all corporate, regulatory and legal guidelines.

#GKOSUS

#LI-Remote

Generous. Innovative. Leadership-driven. Family-oriented. Socially responsible. 

Founded in 1998, Glaukos Corporation is an ophthalmic pharmaceutical and medical technology company focused on developing and commercializing novel therapies for the treatment of glaucoma, corneal disorders, and retinal diseases.

Our mission at Glaukos is to truly transform vision by pioneering novel, dropless therapies that can meaningfully advance the standard of care and improve the lives of patients suffering from chronic, sight-threatening eye diseases. 

Innovation is at the core of everything we do, and we are resolute in our commitment to challenge conventional thinking with new treatment alternatives that are supported by real science, robust clinical evidence, and an unrelenting focus on patients. 

Our constant pursuit of game-changing technologies that disrupt legacy treatment paradigms is encapsulated in the Glaukos mantra "We'll Go First," which articulates our willingness to take chances, our determination to forge new ground, and our commitment to continuous improvement in all that we do.   

Our company completed an initial public offering in June of 2015, and our shares are traded on the New York Stock Exchange under the ticker symbol "GKOS". Our global headquarters is in Aliso Viejo, California with additional locations in San Clemente, California, and Burlington, Massachusetts.

Glaukos Corporation is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law. 

All offers of employment are contingent upon the successful completion of a background check, including successfully passing a drug screen, based on the position and local regulations.