Utilization Management Jobs in Raleigh, NC (NOW HIRING)

Description

The Virtual Reimbursement Manager (VRM) will be responsible for reactively supporting multiple accounts in a specified geographic region through the access process. The VRM will execute the collaborative territory strategic plan through partnership with internal and external stakeholders, which may include sales, market access, and other collaboration partners. Responsibilities include ensuring understanding of coverage, access process and reimbursement services.

In this role, the VRM will demonstrate unwavering support and a consultative approach to help offices obtain insurance authorization and/or reimbursement of products for appropriate patients. The VRM will have a direct impact on a patient's ability to access the therapies they need.

Additional responsibilities include:

• Manage daily activities that support appropriate patient access to our client's products in the provider offices
• Serve as payer expert for defined geography and able to communicate payer changes to key stakeholders in a timely manner
• Offer office education during the entire access process which may include formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, and appeals
• Educate offices using approved materials provided by the client
• Educate physician office staff on the use of our client's patient support services, including web based provider portals

Along with demonstrated initiative, resourcefulness and a results-oriented mindset, the ideal candidate has:

• Bachelor's Degree
• Minimum two years of experience in public or private third party reimbursement or access arena or pharmaceutical industry in managed care or clinical support
• Demonstrated understanding of access, coverage and reimbursement issues in the retail channel, including commercial and federal health care program utilization management tools such as prior authorization, step edits, and denials
• Demonstrated ability to educate offices on access processes - including but not limited to:
  • Experience educating HCPs on client specific Patient Service programs (i.e. copay, bridge, patient assistance, etc.)
  • Experience delivering educational presentations
  • Advanced knowledge of medical insurance terminology
• Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Parts B & D

At Syneos Health, we are dedicated to building a diverse, inclusive and authentic workplace. If your past experience doesn't align perfectly, we encourage you to apply anyway. At times, we will consider transferable skills from previous roles. We also encourage you to join our Talent Network to stay connected to additional career opportunities.

Why Syneos Health? Our ability to collaborate and problem-solve makes a difference in patients' lives daily. By joining one of our field access teams, you will partner with industry experts and be empowered to succeed with the support, resources, and autonomy needed to successfully navigate the complex reimbursement landscape. The diversification and breadth of our new and existing partnerships create a multitude of career paths and employment opportunities. Join our game-changing, global company dedicated to creating better, smarter, faster ways to get biopharmaceutical therapies to patients Experience the thrill of knowing that your everyday efforts are contributing to improving patients' lives around the world.

Work Here Matters Everywhere | How are you inspired to change lives?

Syneos Health companies are affirmative action/equal opportunity employers (Minorities/Females/Veterans/Disabled)

At Syneos Health, we believe in providing an environment and culture in which Our People can thrive, develop and advance. We reward and recognize our people by providing valuable benefits and a quality-of-life balance. The benefits for this position will include a competitive compensation package, Health benefits to include Medical, Dental and Vision, Company match 401k, flexible paid time off (PTO) and sick time. Because certain states and municipalities have regulated paid sick time requirements, eligibility for paid sick time may vary depending on where you work. Syneos Health complies with all applicable federal, state, and municipal paid sick time requirements.

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