Field Reimbursement Manager - Kidney (Northern California - San Francisco, San Jose, Sacramento)
Vertex Pharmaceuticals
June 27, 2026
On-site
California, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices by providing non-promotional access and reimbursement education, troubleshooting to support timely patient access, and using payer expertise.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology care team and office staff involved in prior authorizations and specialty medication access.
- Partner with case management to resolve escalated access issues; manage coordinated handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide follow-up on case status and insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formularies, PA/exception criteria, ICD-10/CPT, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts by patient need and payer dynamics; develop territory engagement plans.
- Follow strict non-promotional, compliant engagement guidelines; maintain patient confidentiality.
Knowledge And Skills (Required/Preferred):
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals/CRM/tools; strong communication, training, relationship-building; analytical and reporting skills.
- Ability to develop/account plans, exercise judgment, travel 50–70%, and use MS Outlook/Word/Excel/PowerPoint/Salesforce.
- Valid driver’s license and meet healthcare representative credentialing requirements.
Education And Experience:
- Bachelor’s degree (health care/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/coverage policies; knowledge of Medicare/Medicaid/commercial insurance.
Pay Range:
$136,000 - $204,000 (eligible for annual bonus and annual equity).
Benefits:
Medical/dental/vision, paid time off (including week-long shutdown in Summer/Winter), educational assistance (incl. student loan repayment), commuting subsidy, 401(k), and more.
Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices by providing non-promotional access and reimbursement education, troubleshooting to support timely patient access, and using payer expertise.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology care team and office staff involved in prior authorizations and specialty medication access.
- Partner with case management to resolve escalated access issues; manage coordinated handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide follow-up on case status and insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formularies, PA/exception criteria, ICD-10/CPT, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts by patient need and payer dynamics; develop territory engagement plans.
- Follow strict non-promotional, compliant engagement guidelines; maintain patient confidentiality.
Knowledge And Skills (Required/Preferred):
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals/CRM/tools; strong communication, training, relationship-building; analytical and reporting skills.
- Ability to develop/account plans, exercise judgment, travel 50–70%, and use MS Outlook/Word/Excel/PowerPoint/Salesforce.
- Valid driver’s license and meet healthcare representative credentialing requirements.
Education And Experience:
- Bachelor’s degree (health care/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/coverage policies; knowledge of Medicare/Medicaid/commercial insurance.
Pay Range:
$136,000 - $204,000 (eligible for annual bonus and annual equity).
Benefits:
Medical/dental/vision, paid time off (including week-long shutdown in Summer/Winter), educational assistance (incl. student loan repayment), commuting subsidy, 401(k), and more.