Field Reimbursement Manager - Kidney (Northern California - San Francisco, San Jose, Sacramento)
Vertex Pharmaceuticals
June 27, 2026
On-site
United States
Market Access
Responsibilities:
- Compliantly build relationships with key nephrology office personnel to support patient access to prescribed specialty medications.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways to support timely patient access.
- Provide timely follow-up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements, access requirements, and payer trends.
- Conduct on-site and virtual in-services/training covering regional payer policies, formulary updates, coverage nuances; PA/medical exception criteria; ICD-10/CPT coding and documentation; distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory independently; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Adapt engagement to existing office workflows; develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to non-promotional guidelines; maintain patient confidentiality and comply with applicable laws and company policies.
Knowledge/Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCPs/office staff for access challenges.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication, training, and relationship-building; analytical and data/reporting skills.
- Ability to execute strategic business/account plans; good judgment in problem solving.
- Travel 50–70% within territory; proficiency in MS Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license and ability to meet credentialing requirements for facility entry.
Education/Experience:
- Bachelor’s degree in healthcare, life sciences, or business; advanced degree is a plus.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies, and payer ecosystems.
- Knowledge of Medicare, Medicaid, and commercial insurance.
Pay Range: $136,000–$204,000 (plus annual bonus and annual equity awards).
Application: Contact Talent Acquisition at ApplicationAssistance@vrtx.com for application assistance.
- Compliantly build relationships with key nephrology office personnel to support patient access to prescribed specialty medications.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways to support timely patient access.
- Provide timely follow-up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements, access requirements, and payer trends.
- Conduct on-site and virtual in-services/training covering regional payer policies, formulary updates, coverage nuances; PA/medical exception criteria; ICD-10/CPT coding and documentation; distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory independently; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Adapt engagement to existing office workflows; develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to non-promotional guidelines; maintain patient confidentiality and comply with applicable laws and company policies.
Knowledge/Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCPs/office staff for access challenges.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication, training, and relationship-building; analytical and data/reporting skills.
- Ability to execute strategic business/account plans; good judgment in problem solving.
- Travel 50–70% within territory; proficiency in MS Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license and ability to meet credentialing requirements for facility entry.
Education/Experience:
- Bachelor’s degree in healthcare, life sciences, or business; advanced degree is a plus.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies, and payer ecosystems.
- Knowledge of Medicare, Medicaid, and commercial insurance.
Pay Range: $136,000–$204,000 (plus annual bonus and annual equity awards).
Application: Contact Talent Acquisition at ApplicationAssistance@vrtx.com for application assistance.