Access & Reimbursement Manager (Nashville, TN)

About Stratis Group

Stratis Group is an independent pharmaceutical consulting firm that specializes in commercialization throughout a brand’s lifecycle. Its core passions include market access, patient services, field reimbursement, and data‑driven analytics.

About the Role

In this contracted, field‑based role, the Access & Reimbursement Manager (ARM) will serve as a dedicated access and reimbursement resource within an assigned territory. The ARM will support appropriate patient access by educating provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources. The role is highly visible within the organization and responsible for providing education to targeted healthcare providers and office staff—including primary care, cardiology, and other client‑defined specialties—regarding access services and reimbursement solutions specific to the product and therapeutic area (Cardiovascular). The ARM will develop and execute a territory access plan, prioritize accounts based on client‑defined objectives, coordinate compliantly with sales, market access, patient services, hub/specialty pharmacy partners, and other matrix stakeholders, and document activities in the approved CRM platform.

Responsibilities

• Ensure understanding of the reimbursement process, particularly in retail pharmacy, field reimbursement services, and payer landscape.
• Abide by defined Rules of Engagement (ROE) and support patient‑level access and reimbursement issue resolution as permitted, accessing PHI only as authorized.
• Demonstrate a compliant, consultative approach to help offices obtain insurance authorization and/or reimbursement for appropriate patients.
• Manage daily activities that support patient access to client products in provider offices and act as liaison to other patient assistance and access support services.
• Provide general education on retail and specialty pharmacy drug prior authorizations, appeals, and denials.
• Conduct in‑person customer visits and participate in client meetings as appropriate.
• Participate in regularly scheduled internal team and cross‑functional meetings and calls.
• Input call activity into the customer CRM as appropriate.
• Serve as the local access and reimbursement expert for the assigned geography, monitoring payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior authorization trends, denial patterns, and other access barriers.
• Communicate relevant changes and field insights to internal stakeholders in a timely and compliant manner.
• Provide office education and awareness throughout the entire access process, including formulary coverage/utilization management criteria, coding, insurance forms & procedures, benefits investigation, prior authorization, appeal, and claims resolution.
• Use only client‑approved materials, messaging, processes, and resources when engaging with healthcare providers, office staff, and field partners.
• Identify and communicate field access insights, payer trends, office workflow barriers, and reimbursement challenges to support continuous improvement.
• Recognize and report adverse events, product complaints, and other reportable information in accordance with client policy and applicable requirements.

Requirements

• 3+ years of experience in one or more of the following areas: Managed Care, Field Reimbursement, Patient Services, and/or Sales (Specialty or Biologics), or healthcare provider office practice management.
• Ability to travel 3‑4 days a week, with overnights as needed; must reside within the territory.
• Valid driver’s license.

Qualifications

• 4‑year degree in a related field or equivalent experience.
• Cardiovascular/Cardiology and hospital healthcare systems experience a plus.

Skills

• Solution‑oriented mindset, strong business acumen, and strong analytic capabilities.
• Experience and understanding of retail and specialty pharmacies.
• Demonstrated ability to educate offices on access processes and issue resolution.
• Experience educating HCPs and office staff on client‑specific patient service programs (e.g., copay assistance).
• Ability to deliver educational presentations in person and via technology platforms such as Zoom, Webex, and Teams.
• Advanced knowledge of medical insurance terminology.
• Knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, with expertise in Medicare Part D for pharmacy‑benefit products.
• Proven ability to develop and maintain trusted relationships with internal partners and work effectively in teams.
• Ability to manage ambiguity and solve problems.
• Experience preparing and submitting expense reports in a timely fashion.