Clinical Director (Payer-Focused Consulting)

Advantage Point Solutions (APS), part of The Lockwood Group, is a unique pharmaceutical consulting agency working with Pharmaceutical Manufacturers and Payers, delivering results for both. Our team of knowledgeable professionals has defined groundbreaking formulary, contracting and outcomes strategies for over 20 years. The core of these strategies has always been valued for both payers and manufacturers.

Position Overview:

The Clinical Director will be an integral member of the APS team with day-to-day responsibilities for supporting APS staff and its clients with drug information, pharmacotherapy and disease state expertise across a broad range of orphan, ultra-orphan, specialty and traditional drugs and conditions. The position will require expert level drug information skills combined with a comprehensive understanding of the PBM and health plan payer landscape.

This should include knowledge of payer behaviors and practices around formulary management and coverage management in the Commercial and Medicare marketplaces, as well as a good working knowledge of drug distribution channels and the different players and entities in these spaces. The Clinical Director will use their clinical and payer landscape expertise to inform and provide internal strategic insight generation, clinical perspectives, and participate in client-facing engagements.

Job 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 research activities needed to gain an understanding of how various payer lines of business will perceive and manage new drugs and new indications being pursued by APS’ clients

Serve as a resource to all APS staff and its clients regarding the rationales and approaches that payers use when developing Prior Authorizations, step-therapy edits and other coverage rules

Prepare Word documents, PowerPoint slides or other formats describing the commercial viability, Pros and Cons, relevant competition and likely payer coverage management practices for new business development assets being considered by APS’ clients

Plan, conduct and concisely summarize payer research involving products being pursued by APS’ clients

Help to plan, develop and moderate virtual and in-person payer advisory boards involving assets and issues of interest to APS’ clients.

• Review and improve client value proposition presentations, including preapproval information exchange (PIE) presentations, to better address payer needs and perspectives
• Interact with APS’ current and prospective clients and demonstrate that APS is an organization with deep understanding and knowledge of drugs and drug therapy
• Assist in the preparation and augmenting of statements of work (SOW) that APS prepares for new business and participate in client presentations to win new business
• Keeping current with marketplace trends related to clinical use of drugs and payer formulary and coverage management practices
• Collaborates with the APS Chief Clinical Officer and VP of Clinical Services to achieve APS’ and its clients’ goals and objectives
• Works as a critical member of the entire APS team to achieve APS, Nexus and affiliated company objectives,

Qualifications:

• PharmD degree or equivalent e.g., BS pharmacy with advanced degree
• At least 5 to 10-years of experience in a managerial/supervisory drug information position with a payer, i.e., health plan or PBM, in the areas of formulary development, coverage management, and benefit design
• Comprehensive understanding of current payer organizations and payer regulatory landscape in Commercial and Medicare
• Drug information experience with payers in developing drug monographs, class reviews, drug formularies, coverage criteria, appeals criteria, clinical policies, etc.
• Experience with the Commercial and Medicare lines of business, experience in Medicaid is also desirable, but not required
• Experience in benefit design, coverage determination, benefit allocation, coverage review and appeal processes, etc.
• Experience in P&T committee processes
• Excellent written and verbal communication skills
• Dedication to life-long learning and development
• Ability to facilitate/moderate virtual or in person payer advisory boards and payer advisory panels
• Ability to collaborate and support other clinical and non-clinical experts within APS and other Lockwood companies to jointly achieve company and client objectives
• Excellent time management skills and ability to meet agreed upon deadlines
• #APS