Field Reimbursement Manager - Kidney (Chicago, IL)
Vertex Pharmaceuticals
August 14, 2026
Remote friendly (Illinois, United States)
United States
Market Access
Key Duties And Responsibilities
- Build compliant relationships with nephrology care teams and office staff to support prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways to support timely patient access.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Create territory engagement plans to reduce patient-specific access barriers; follow strict non-promotional and privacy/compliance requirements.
Knowledge And Skills
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Ability to navigate payer portals, CRM systems, and field access tools; strong training/relationship skills.
- Analytical skills using data/reporting to manage caseload and prioritize.
- Experience developing/executing account plans; sound judgment.
- Travel 50–70%; Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet healthcare credentialing requirements.
Education And Experience
- Bachelor’s degree (healthcare/life sciences/business); advanced degree a plus.
- 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access.
- Deep understanding of benefits investigations, PA processes, appeals, and coverage policies; Medicare/Medicaid/commercial payer knowledge.
Pay Range
- $136,000–$204,000
- Build compliant relationships with nephrology care teams and office staff to support prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways to support timely patient access.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Create territory engagement plans to reduce patient-specific access barriers; follow strict non-promotional and privacy/compliance requirements.
Knowledge And Skills
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Ability to navigate payer portals, CRM systems, and field access tools; strong training/relationship skills.
- Analytical skills using data/reporting to manage caseload and prioritize.
- Experience developing/executing account plans; sound judgment.
- Travel 50–70%; Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet healthcare credentialing requirements.
Education And Experience
- Bachelor’s degree (healthcare/life sciences/business); advanced degree a plus.
- 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access.
- Deep understanding of benefits investigations, PA processes, appeals, and coverage policies; Medicare/Medicaid/commercial payer knowledge.
Pay Range
- $136,000–$204,000