Field Reimbursement Manager - Kidney (Pacific Northwest - WA, OR, ID, WY, MT, AK)
Vertex Pharmaceuticals
June 27, 2026
On-site
Idaho, United States
Market Access
Key Duties And Responsibilities
- Compliantly establish connections with key nephrology office personnel (care team and administrative staff for prior authorizations and specialty medication access).
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Support timely patient access by educating offices on copay, PAP, Bridge programs, and other affordability pathways.
- Provide timely follow-up on case status and ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government prescription insurance coverage requirements, access needs, and payer trends.
- Conduct compliant on-site and virtual in-services/training on regional payer policies, formulary updates, coverage nuances; PA/medical exception criteria; coding/billing (ICD-10, CPT) and documentation; distribution pathways, hub services, enrollment processes, and reimbursement workflows.
- Independently manage a multistate geographic region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to strict non-promotional guidelines; maintain patient confidentiality and comply with applicable laws/regulations and company policies.
Knowledge And Skills
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices to navigate complex access challenges.
- Navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building; analytical and data/reporting skills.
- Ability to develop/execute strategic business/account plans; use sound judgment.
- Travel 50–70% within territory; Microsoft Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education And Experience
- Bachelor’s degree in health care, life sciences, or business (advanced degree preferred).
- 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field-based access roles.
- Deep understanding of benefits investigations, PA, appeals, coverage policies, and payer ecosystems.
- Knowledge of Medicare, Medicaid, and commercial insurance plans.
Pay Range: $136,000 - $204,000
Application instructions: N/A
- Compliantly establish connections with key nephrology office personnel (care team and administrative staff for prior authorizations and specialty medication access).
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Support timely patient access by educating offices on copay, PAP, Bridge programs, and other affordability pathways.
- Provide timely follow-up on case status and ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government prescription insurance coverage requirements, access needs, and payer trends.
- Conduct compliant on-site and virtual in-services/training on regional payer policies, formulary updates, coverage nuances; PA/medical exception criteria; coding/billing (ICD-10, CPT) and documentation; distribution pathways, hub services, enrollment processes, and reimbursement workflows.
- Independently manage a multistate geographic region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to strict non-promotional guidelines; maintain patient confidentiality and comply with applicable laws/regulations and company policies.
Knowledge And Skills
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices to navigate complex access challenges.
- Navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building; analytical and data/reporting skills.
- Ability to develop/execute strategic business/account plans; use sound judgment.
- Travel 50–70% within territory; Microsoft Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education And Experience
- Bachelor’s degree in health care, life sciences, or business (advanced degree preferred).
- 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field-based access roles.
- Deep understanding of benefits investigations, PA, appeals, coverage policies, and payer ecosystems.
- Knowledge of Medicare, Medicaid, and commercial insurance plans.
Pay Range: $136,000 - $204,000
Application instructions: N/A