Remote Utilization Management Jobs in Pennsylvania

Life Unlimited. At Smith+Nephew, we design and manufacture technology that takes the limits off living.

We're looking for a strategic and relationship-focused National Account Manager, Payor Relations to help drive market access and reimbursement success across our Sports Medicine portfolio.

As the National Account Manager, Payor Relations - Sports Medicine, you will play a critical role in executing payer engagement strategies that support patient access to innovative technologies. Partnering closely with national and regional health plans, you will build and maintain strategic relationships, identify opportunities to improve coverage and reimbursement, and help reduce barriers to care.

Reporting to the Director, Payor Relations - Sports Medicine, you will serve as a key liaison between payer organizations and internal cross-functional teams, providing market insights and supporting evidence-based market access initiatives aligned with business objectives.

• Develop and maintain strategic relationships with national and regional payer organizations.
• Execute payer engagement strategies that support coverage expansion, reimbursement optimization, and patient access.
• Serve as the primary account lead for assigned payer accounts, coordinating communications and issue resolution.
• Conduct regular business reviews and identify opportunities to strengthen coverage policies and reduce reimbursement challenges.
• Collaborate with reimbursement, market access, marketing, medical affairs, and product management teams to address customer needs and advance business objectives.
• Present clinical evidence, health economic analyses, and real-world outcomes data to payer decision-makers.
• Provide market intelligence and customer insights to support value proposition development, evidence generation priorities, and strategic planning.
• Maintain accurate account plans, engagement records, and opportunity tracking.
• Communicate account performance, emerging risks, and access opportunities to leadership.

• Bachelor's degree required.
• 5+ years of experience in payer relations, market access, managed care, reimbursement, national accounts, or a related healthcare field.
• Strong understanding of U.S. reimbursement systems, including coding, coverage, payment methodologies, utilization management, and medical policy development.
• Experience presenting clinical and economic value propositions to payer audiences.
• Demonstrated success engaging with national and regional health plans.
• Advanced degree (MBA, MPH, MHA, or related field).
• Experience within medical devices, orthopaedics, sports medicine, or related healthcare sectors.
• Established relationships with payer decision-makers across national and regional organizations.

You are a highly collaborative professional who combines strategic thinking with strong relationship management skills. You are comfortable working across functions, influencing stakeholders, and communicating complex clinical and economic data in a compelling and compliant manner.

Key competencies include:

• Market access and reimbursement expertise
• Strategic account management
• Clinical and health economic value communication
• Cross-functional collaboration and influence
• Executive-level presentation skills
• Ethical decision-making and compliance focus

• Remote-based role within the United States
• Up to 40% travel required

You Unlimited.

We believe in creating the greatest good for society. Our strongest investments are in our people and the patients we serve.

• Inclusion and Belonging-Committed to Welcoming, Celebrating and Thriving on Inclusion and Belonging, Learn more aboutEmployee Inclusion Groupson our website (https://www.smith-nephew.com/).
• Your Future: 401k Matching Program, 401k Plus Program, Employee Stock Purchase Plan, Tuition Reimbursement
• Work/Life Balance: Flexible Personal/Vacation Time Off, Paid Holidays, Flex Holidays, Paid Community Service Day
• Your Wellbeing: Medical, Dental, Vision, Health Savings Account (Employer Contribution of $500+ annually), Employee Assistance Program, Parental Leave, Fertility and Adoption Assistance Program
• Flexibility: Hybrid Work Model (For most professional roles)
• Training: Hands-On, Team-Customized, Mentorship
• Extra Perks: Discounts on fitness clubs, travel and more!

The anticipated base compensation range for this position is $104,000 - 198,000USD annually. The actual base pay offered to the successful candidate will be based on multiple factors, including but not limited to job-related knowledge/skills, experience, geographical location, and internal equity. It is not typical for an individual to be hired at the high end of the range for their role at Smith + Nephew. Compensation decisions are dependent upon the facts and circumstances of each position and candidate. In addition to base pay, we provide competitive bonus and benefits, which include medical, dental, and vision coverage, 401k, tuition reimbursement, medical leave programs, parental leave, and generous PTO, paid company holidays annually and 8 hours of Volunteer time and a variety of wellness offerings such as EAP.

Smith+Nephew provides equal employment opportunities to applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability.