Clinical Director (Payer-Focused Consulting)

About the role

The Clinical Director will be an integral member of the APS team, supporting staff and clients with drug information, pharmacotherapy, and disease state expertise across orphan, ultra-orphan, specialty, and traditional drugs and conditions. This role requires expert-level drug information skills combined with a comprehensive understanding of the PBM and health plan payer landscape, including payer behaviors and practices around formulary and coverage management in Commercial and Medicare marketplaces, as well as knowledge of drug distribution channels.

Responsibilities

• Provide expert opinions to APS and its clients regarding the clinical value of drugs to payers and how they will be perceived and managed by payers.
• Support APS and its clients with broad-based drug information expertise in all therapeutic areas, including ultra-orphan, orphan, and non-orphan disease states.
• Conduct drug information research and other activities to understand how various payer lines of business will perceive and manage new drugs and indications.
• Serve as a resource to APS staff and clients regarding payer rationales and approaches for developing Prior Authorizations, step-therapy edits, and other coverage rules.
• Prepare documents (Word, PowerPoint, etc.) describing commercial viability, pros and cons, competition, and likely payer coverage management practices for new business development assets.
• Plan, conduct, and summarize payer research involving products pursued by APS clients.
• Help plan, develop, and moderate virtual and in-person payer advisory boards for assets and issues of interest to clients.
• Review and improve client value proposition presentations, including preapproval information exchange (PIE) presentations, to address payer needs and perspectives.
• Interact with current and prospective clients to demonstrate APS’s deep understanding of drugs and drug therapy.
• Assist in preparing and augmenting statements of work (SOW) for new business and participate in client presentations to win new business.
• Stay current with marketplace trends related to clinical drug use and payer formulary and coverage management practices.
• Collaborate with the APS Chief Clinical Officer and VP of Clinical Services to achieve APS and client goals.
• Work as a critical member of the APS team to achieve company and affiliated objectives.

Qualifications

• PharmD degree or equivalent (e.g., BS Pharmacy with an advanced degree).
• At least 5–10 years of experience in a managerial/supervisory drug information position with a payer (health plan or PBM), including formulary development, coverage management, and benefit design.
• Comprehensive understanding of current payer organizations and the regulatory landscape in Commercial and Medicare markets.
• Experience developing drug monographs, class reviews, drug formularies, coverage criteria, appeals criteria, and clinical policies.
• Experience with Commercial and Medicare lines of business; Medicaid experience is desirable but not required.
• Experience in benefit design, coverage determination, benefit allocation, coverage review, and appeal processes.
• Experience with P&T committee processes.
• Excellent written and verbal communication skills.
• Dedication to lifelong learning and development.
• Ability to facilitate/moderate virtual or in-person payer advisory boards and panels.
• Ability to collaborate with clinical and non-clinical experts within APS and other Lockwood companies.
• Strong time management skills and ability to meet deadlines.