Manager, Coverage Analysis – Budget

🕒 October 13

🏄 California – Remote

🏄 California – Remote

💵 $129.2k - $193.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Sutter Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded Sutter Health was founded in 1996.

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

💰 Grant on 2016-11

Healthcare • Healthcare Insurance • Non-profit

Sutter Health is a not-for-profit health system serving Northern California, offering a wide range of healthcare services. It provides comprehensive primary and specialty care, including mental health, oncology, orthopedics, women's health, and more. The organization supports both in-person and virtual visits, ensuring accessibility to its services. Sutter Health is also involved in medical research, education, and offers various health plans, including Sutter Health Plus. It emphasizes innovative, compassionate care and maintains a network of hospitals, medical groups, and other health providers across Northern California.

📋 Description

• Lead and perform clinical research pre-award activities associated with Medicare coverage analysis and protocol-driven budget development • Negotiate with sponsors and clinical research organizations • Conduct financial feasibility analysis and align study financial terms with institutional requirements • Ensure the quality, timeliness, and consistency of coverage analyses and budgets across the enterprise research portfolio • Lead staff and daily operations as a working manager • Maintain an assigned study portfolio and serve as escalation point for complex oncology, cardiovascular, device, multi-arm, and other high-risk studies • Partner with research operations, contracting, legal, compliance, finance, revenue cycle, Epic teams, investigators, and external sponsors • Move studies from protocol intake through executable budget terms and activation readiness • Establish standardized workflows, workload controls, quality review, training, performance expectations, and key performance indicators • Provide subject-matter expertise on Medicare Clinical Trial Policy, National and Local Coverage Determinations, device coverage categories, coding and billing considerations, payer allocation, research cost identification, and clinical trial financial practices

🎯 Requirements

• Equivalent experience will be accepted in lieu of the required degree or diploma • Bachelor's degree in Accounting, Finance, Business Administration, or related field, unless substituted by equivalent experience • 5 years of recent relevant experience • Advanced knowledge of clinical research pre-award operations, protocol interpretation, Medicare coverage analysis, clinical trial budgeting, sponsor negotiation, and research billing compliance • Working knowledge of Medicare Clinical Trial Policy, Medicare coverage guidance, National and Local Coverage Determinations, investigational device concepts, medical coding, payer requirements, and Good Clinical Practice • Ability to translate complex protocols into auditable coverage and financial decisions • Strong people leadership, workload management, judgment, negotiation, conflict resolution, written communication, and stakeholder management skills • Advanced analytical capability with financial models, pricing assumptions, variance review, performance metrics, and data-informed process improvement • Ability to manage multiple priorities and make complex and sensitive decisions independently within delegated authority • Ability to escalate material compliance, financial, or operational risk appropriately

🏖️ Benefits

• Comprehensive benefits package • Total rewards program • Regular employee status • Exempt position • Monday–Friday schedule • No weekend requirements

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