Clinical Director (Payer-Focused Consulting)

Responsibilities

• Provide expert opinions to APS and its clients regarding the clinical value of drugs to payers
• Support APS and its clients with broad-based drug information expertise across all therapeutic areas
• Conduct drug information research to understand how payer lines of business perceive and manage new drugs
• Serve as a resource regarding rationales and approaches used by payers for Prior Authorizations and step-therapy edits
• Prepare documents and presentations describing commercial viability and payer coverage management practices
• Plan, conduct, and summarize payer research
• Help to plan, develop, and moderate payer advisory boards
• Review and improve client value proposition presentations, including preapproval information exchange (PIE) presentations
• Interact with current and prospective clients to demonstrate deep drug therapy knowledge
• Assist in the preparation of statements of work (SOW) and participate in client presentations
• Keep current with marketplace trends related to clinical use of drugs and payer formulary management
• Collaborate with APS leadership to achieve company and client objectives

Requirements

• PharmD degree or equivalent (e.g., BS pharmacy with advanced degree)
• 5 to 10 years of experience in a managerial/supervisory drug information position with a payer (health plan or PBM)
• Comprehensive understanding of current payer organizations and the regulatory landscape in Commercial and Medicare
• Experience with payers in developing drug monographs, class reviews, drug formularies, coverage criteria, and clinical policies
• Experience with Commercial and Medicare lines of business (Medicaid experience is desirable)
• Experience in benefit design, coverage determination, and appeal processes
• Experience in P&T committee processes
• Excellent written and verbal communication skills
• Ability to facilitate/moderate virtual or in-person payer advisory boards
• Excellent time management skills and ability to meet deadlines