Field Reimbursement Manager - Kidney (Michigan-North Ohio)

General Summary Field-based role supporting nephrology practices with non-promotional access and reimbursement education for Vertex kidney therapies; troubleshoot and apply territory-level payer expertise to ensure timely patient access. Key Duties And Responsibilities Establish compliant connections with nephrology office personnel involved in prior authorizations and specialty medication access. 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. Follow up on case status; ensure offices understand insurance documentation requirements. Maintain understanding of commercial and government prescription coverage requirements, including payer trends. Conduct on-site/virtual in-services and training on regional payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding, documentation, distribution/hub services, enrollment, and reimbursement workflows. Independently manage a multistate geographic region; prioritize accounts based on patient need, payer dynamics, and KPSP demand. Develop territory engagement plans; adhere to non-promotional and compliance/privacy guardrails. Maintain patient health information confidentiality; apply program business rules for a consistent, compliant experience. Knowledge And Skills Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP/office staff. Ability to navigate payer portals, CRM systems, and field access tools; strong communication/training/relationship building. Analytical and data/reporting skills; strategic account plan execution. Travel 50–70% within territory; Microsoft Office (Outlook/Word/Excel/PowerPoint) and Salesforce CRM proficiency. Valid driver’s license; meet health care representative credentialing requirements. Education And Experience Bachelor’s in health care, life sciences, or business; advanced degree a plus. 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles. Deep knowledge of benefits investigations, PA, appeals, coverage policies, and payer ecosystems; Medicare/Medicaid/commercial plan expertise. Pay Range $136,000 - $204,000 Benefits Annual bonus and annual equity awards; potential overtime eligibility (per federal/state requirements). Medical/dental/vision, paid time off, educational assistance (student loan repayment), commuting subsidy, matching charitable donations, 401(k). #J-18808-Ljbffr