Loading...
Share this Job

Director, Reimbursement & Government Affairs- US (Washington D.C)

Norcross, US

Ref. number:  2526

At Molnlycke, we care about making people better - those who work for us, those who work with us, and we prove it every day! 

In our daily work, we create unique medical solutions to improve quality of life. We enjoy what we do because it makes a real difference in people’s lives. Although we’re a global company, we’re still small enough for you to make your mark. Our leaders are accessible and trust us to make the right decisions. As a Mölnlycke employee, you’ll thrive when you take on the responsibility.      

We are currently searching for  Director, Reimbursement & Government Affairs  . This person will be based in their Home Office and prefer they live in the Washington D.C. Metro or surrounds.  

The Director, Reimbursement & Government Affairs supports Mölnlycke Health Care’s (MHC) United States (US) market by implementing the commercial platform for reimbursement solutions with sales revenue streams that includes federal policy and legislation, i.e.: CMS Value Based Programs (Hospital Acquired Conditions, Readmissions, Value Based Purchasing, IMPACT Act).  Primary focus for this role, will be to develop strategy and execution tactics and actions to ensure  national and local reimbursement through evidence based outcomes, clinical and health economics; focused on coverage, coding and payment for current portfolio solutions and future launches.  Additional focus will be expanding public policy with Capitol Hill, Health & Human Services and Industry Advocacy Organizations (NPIAP, AAWC, AORN, WOCN, SHM),  to positively impact reduction of Pressure Injuries hospital / community acquired infections. Through these activities, MHC can ensure success of short-term and long-term business objectives.  In addition, this role will work with WC, SUR, PAC, SAHE partners as well as  global Health Economics & Government Affairs (HEGA) team, as a US subject matter expert as directed by the VP - SAHE.

KEY ACCOUNTABILITIES

Reimbursement

•Lead all Reimbursement & necessary Government Affairs activities for the US business

•Under direction of the Vice President, is responsible for developing strategy and executing Durable Medical Equipment applications, coding for product solutions as appropriate (HCPCS), as well interfacing with Government (Medicare, Medicaid, Managed Medicare and Medicaid (example Centene), Durable Medical Equipment Carriers such as Palmetto, and Commercial Payers (Aetna, Anthem, Cigna, Humana, Kaiser, United Healthcare).

•Collaborate with Internal global stakeholders on policy issues, new business development, and leverage of global and US initiatives such as, Hospital Acquired Infection (HAIs), Community Acquired Infection (CAI), Surgical Site Infection (SSIs), along with Standardization and Utilization.

•Leads development and implementation customer strategies and monitor projects supporting field pull through of account wins collaborating with headquarters cross-functional teams on reimbursement and payer areas.

•Monitor, analyze and influence commercial, Medicare, and Medicaid payer market and develop strategy with senior management.

•Develop and execute pull-through strategies on CMS Value Based Programs with ASDs, RMs and DSAs to ensure the appropriate level of cross-functional support for customers within a defined geography

•Establish collaborative “C” Suite partnerships with payers, channel players, and hospital systems to develop and implement strategies that ensure patients access and improve revenue streams for Molnlycke.

•Implement with Marketing, Training and cross functional business partners translational knowledge of the payer evidence and commercial strategy development processes in a timely and accurate fashion

•Increase organizational competency through Power Hours, NSM and ASM venues of payer landscape and reimbursement trends.

•Keep current on marketplace health care issues/strategies, customer issues/trends and best practices

•Analyze, evaluate, and apply for reimbursement codes with both CMS for new coding as well as PDAC – HCPCS coding for new and existing MHC products HCPCS

•Develop with VP SAHE, Senior Directors Strategic and National Accounts and Director of Health Economics business planning and outcomes metrics including but not limited to: stakeholder heat maps, and subsequent development of business planned targets.

 

 Government Affairs

  • Lead all Government Affairs activities for the US business
  • Develop and advocate policy and technical regulatory positions on pressure ulcer prevention, hospital-acquired infections, reimbursement, and value based programs, IMPACT ACT.
  • Collaborate with Internal global stakeholders on policy issues, new business development, and leverage of global and US initiatives.
  • Responsible for identifying and communicating relevant legislative, political and regulatory trends and events through multiple media
  • Establish and maintain relationships with HHS, CMS, CMMI, AHRQ and CCSQ, VA DoD officials .
  • Additional responsibilities include where appropriate, Capitol Hill public policy activities  with key opinion leaders (RN, MD, PhD advocates), solution requests meetings with Members of the U.S. House and Senate for specific disease state / prevention and treatment areas.
     
    Sales Excellence
  • Act as Hybrid Health Economic Solutions Director in Post-Acute
  • Execute on ACA / ACHA & CMS for Customer Messaging with field sales, Strategic Accounts, Health Economics Solutions Team and Marketing.
  • Collaborate with internal stakeholders to translate and develop tools and customer facing messaging on BIG data management of ACA outcomes quality initiatives, such as the Value Based Purchasing, Readmissions Reduction Act and IMPACT Act.
  • Develop and facilitate new hire sales training as well as NSM reimbursement and health economic sales force education with Sales Training
  • Develop training modules for ongoing training curriculum, including new hire sales training for the US sales team on MS-DRG, DMEPOS / PDAC, HCPCS, IPPS and OPPS, ASC, LTCAH, and SNF coding, coverage and reimbursement
  • Develop sales execution in collaboration with SAHE LT and especially the Director, Health Economics, as well as Global GRH team, and clinical team
  • Reimbursement -  Establish collaborative “C” Suite partnerships with payers, channel players, and hospital systems to develop and implement strategies that ensure patients access utilizing approved medical policy, reimbursement, coding, and coverage for all sites of care (ACUTE and POST-ACUTE).
  • Government Affairs - Responsible for advocating for best patient outcomes with Members of the U.S. House and Senate .
  • Sales Excellence - Collaborate with internal stakeholders to translate and develop tools and customer facing messaging on BIG data management of ACA outcomes quality initiatives, such as the Value Based Purchasing, Readmissions Reduction Act and IMPACT Act .

COMPETENCIES

  • Coding, Coverage and Payment experience with documented success in gaining approval for reimbursement codes in the medical device marketplace
  • Ability to influence and communicate the ACA / Medicare and VA / DoD policies and mandates for acute and post-acute setting for WC and SUR
  • Demonstrated “C” Suite Platform Skills – verbal, written and translatable
  • Demonstrated competency in alternative payment models, such as risk arrangements, and innovative models
  • Reimbursement Launch Expertise
  • Senior leadership responsibilities and experiences in developing “C” Suite and Government Official Relationships
    QUALIFICATIONS AND EXPERIENCE
  • Bachelor’s degree within business administration, health economics, health policy, health care administration, or related field required from accredited college/university; 
  • Advanced degree preferred; MSA, MPH, MBA, etc.
  • At least 5+ years of demonstrated medical device or pharmaceutical experience in coding, coverage and payment with payer relations (Reimbursement - Medicare, Medicaid and or Commercial Insurance, health policy, outcomes research),
  • Customer facing experience
  • Government Affairs, VA & DoD, Indian Health Services, and other government entity experience is a plus
  • Experience in representing company objectives to payers e.g. The Centers for Medicare & Medicaid Services (CMS),  and private payers such as Anthem BCBS, Aetna, Cigna, Humana, United, Kaiser, Centene
  • Successful candidate must demonstrate excellent platform skills: including written and verbal communication, business acumen; and collaborating with internal and external stakeholders at the “C” Suite level
  • Experience working through US reimbursement challenges, including change management to payment policies, indicative of the Affordable Care Act mandates;
  • Experience with shaping positive outcomes in response to market access conditions and US health policy trends
  • Experience presenting to “ C” Suite level customers, field sales, Strategic Accounts, Leadership Team members and global counterparts
    ADDITIONAL INFORMATION
  • Must be able to travel domestically up to 50% and internationally if needed;
  • Experience with project / vendor management
  • Strong platform skills:  including verbal and written communication and presentation abilities to multiple stakeholders at senior and junior levels of an organization;
  • Demonstrated ability to provide simple, translational information on complex issues such as Reimbursement, Government Issues and Public Policy
  • Demonstrated problem-solving capabilities; and ability to handle multiple tasks at one time;
  • Demonstrated ability to lead without authority, and influence others despite level or role
  • Demonstrated understanding of organizational behaviour, corporate culture and to be able to flourish in a complex and rapidly evolving workplace;
  • Comprehensive understanding of the medical device industry in the acute and post-acute settings in both SUR and WC product solution area
     

 

 

 

About Mölnlycke  

Mölnlycke is a world-leading medical solutions company. We design and supply solutions to enhance performance at every point of care – from the hospital to the home.   

We specialize in:   

  • Wound management: including dressings with Safetac® such as Mepitel® and Mepilex®  
  • Preventing pressure ulcers: with Mepilex® Border used prophylactically and devices to help turn and re-position patients  
  • Surgical solutions: including Mölnlycke trays, HiBi® antiseptics and Biogel® surgical gloves  

Mölnlycke was founded in 1849. Nowadays our solutions are available in around 100 countries; we’re the number one global provider of advanced wound care and single-use surgical products; and we’re Europe’s largest provider of customized trays. Our headquarters are in Gothenburg, Sweden and we have about 7,800 employees around the world.  


Nearest Major Market: Atlanta