Director – Medical Policy

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Caris Life Sciences

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2008

🧬 Biotechnology

⚕️ Healthcare Insurance

🤖 Artificial Intelligence

Biotechnology • Healthcare Insurance • Artificial Intelligence

Caris Life Sciences is a leading innovator in the field of molecular science, focusing on providing cancer patients and oncologists with comprehensive molecular information to revolutionize cancer care. The company specializes in precision medicine, using advanced technologies like molecular profiling and artificial intelligence to understand cancer at a molecular level, offering better treatment options for patients. Caris Life Sciences integrates these technologies with clinical trial solutions and biopharma to enhance cancer research and treatment solutions. Their commitment is to improve as many lives as possible through transformative medical science.

📋 Description

• Monitor and analyze payer and LBM medical policies, coverage decisions and reimbursement trends across commercial and government payers to assess impact on company pipeline • Interpret payer and policy changes and communicate implications to the broader internal stakeholders • Clinical and product expert for the Market Access team and responsible for presenting clinical data to market access policy makers, including Medical Directors and Medical Policy groups, and meetings and conferences • Own and support the development of evidence generation plans, value propositions and technical assessment submission packages to submit to gain coverage of Caris products to assigned payers and LBMs • Engage with payer stakeholders including Medical Directors and Medical Policy contacts to communicate updates to data and to advocate for coverage of Caris's tests • Maintain policy relationships with industry, including trade associations and professional societies • Support National and State legislative initiatives advocating for coverage of evidence-based biomarkers for all cancer patients to improve access and promote health equality • Market Access representative and advocate in strategic and tactical planning within the business units, focused on evidence generation, product development, and commercialization from a Payer perspective • Partner with market access, marketing, HEOR and other related solutions teams to support the execution of business plans for the business unit • Closely track and understand professional society guidelines and technology assessments that influence payer policy decisions • Ability to work in a deadline-driven and fast-paced environment, including managing multiple projects on time and within budget completion • Ability to use expert knowledge and judgment to make sound decisions • Ability to effectively collaborate, interface, and influence with all levels of an internal organization • Ability to lead, manage, and prioritize strategies, initiatives, and workload independently and proactively in a fast-paced, entrepreneurial environment • Adaptable, open to change, and ability to work in ambiguous situations and respond to new information and unexpected circumstances • Ability to develop a value proposition and effective business case to influence medical policy • Apply outstanding problem solving, project and program management skills • Exercise strong analytical and business skills; ability to communicate effectively with high level executives • Exercise strong collaboration, influencing, project management, organizational, and change management skills • Exercise strong oral and written communication and presentation skills • Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork • Maintain regular and reliable attendance • Develop and maintain payer engagement strategies to support long-term access and reimbursement goals • Lead internal training sessions to educate commercial and medical teams on payer trends and policy changes • Track and report on key performance indicators (KPIs) related to payer coverage, policy wins, and access milestones • Collaborate with Clinical Development and HEOR to align evidence generation with payer expectations • Support pricing strategy development by providing insights into payer value perception and reimbursement benchmarks • Represent the company at external policy forums, payer advisory boards, and industry coalitions

🎯 Requirements

• Advanced clinical or scientific degree (e.g., PharmD, PhD, MS in Genetic Counseling, NP, PA, or equivalent) • Minimum 7 years of experience in medical policy, market access, or related roles in biotech, diagnostics, or healthcare • Demonstrated experience engaging with payers, including Medical Directors and policy decision-makers • Strong knowledge of U.S. healthcare reimbursement systems, including CMS and commercial payers • Proven ability to develop and communicate evidence-based value propositions • Excellent analytical, communication, and presentation skills • Experience working cross-functionally in a matrixed organization • Deep scientific understanding and practical application of oncology biomarkers and companion diagnostics • Strong understanding of digital health and real-world evidence generation • Ability to communicate technical and non-technical information to scientific and non-scientific colleagues/clients • Strong interpersonal and peer leadership skills to influence without authority • A strategic thinker with excellent verbal, written and presentation skills to get buy-in and drive consensus within the team and the rest of the organization

🏖️ Benefits

• Highly competitive and inclusive medical, dental and vision coverage options • Health Savings Account for medical expenses and dependent care expenses • Flexible Spending Account to pay for certain out-of-pocket expenses • Paid time off, including: vacation, sick time and holidays • 401k match and Financial Planning tools • LTD and STD insurance coverages, as well as voluntary benefit options • Employee Assistance Program • Pet Insurance • Legal Assistance • Tuition Assistance