Posted 3 days ago
National Account Director
AI Summary
The National Account Director owns payer access and coverage strategy for national and regional commercial payers, PBMs, and IDNs, leading value-based discussions and negotiations to secure coverage and reimbursement for Capricor’s lead cell therapy Deramiocel.
About this role
Responsibilities
-
Own the access and coverage strategy for an assigned set of national and regional payers, PBMs, and IDN accounts; develop and execute account-specific business plans aligned with Capricor's launch and access objectives.
-
Lead value-based clinical, HEOR, and budget-impact discussions with medical directors, pharmacy directors, P&T committees, and policy teams to drive timely and appropriate medical policy positions.
-
Navigate the buy-and-bill, medical-benefit, and specialty-pharmacy access pathways unique to infused cell therapies.
-
Partner with the Market Access Leadership team on Pricing & Contracting appropriate to a rare-disease, cell therapy economics profile.
-
Lead account-level negotiations on coverage, coding, utilization management, and contracting in coordination with Market Access leadership.
-
Build and maintain trusted senior-level relationships with payer leadership across assigned accounts.
-
Deliver compelling, compliant clinical, economic, and patient-centered presentations using AMCP dossiers, value decks, and approved access materials.
-
Monitor coverage decisions, medical policy changes, and utilization management positions across assigned accounts; flag risks and opportunities in real time.
-
Payer account (government & commercial) profiling, business plan creation, and strategic execution with top payer / customer accounts.
-
Establish access goals, productivity measures, and ensure account plans are created and executed annually.
Internal Coordination & Intelligence
-
Partner with Trade & Patient Services to ensure smooth coverage navigation, prior authorization, and case management for patients in the assigned geography.
-
Partner with Sales, Medical Affairs, and MSLs to align account-level engagement with broader commercial and scientific activities, in full compliance with channel and engagement rules.
-
Provide structured payer intelligence and account insights back to Market Access leadership to inform pricing, contracting, and strategic positioning.
-
Maintain accurate account plans, CRM activity, and reporting cadence; participate in business reviews and launch readiness forums.
-
Perform other duties as may be assigned from time to time.
Requirements
-
Bachelor's degree required; advanced degree (MBA, PharmD, MPH, or related) preferred.
-
10+ years of biotech / pharma U.S. Market Access experience, including 5+ years in a National Account Director or equivalent senior payer-facing role.
-
Demonstrated success securing coverage for high-cost specialty, rare disease, or cell / gene therapy products in the medical-benefit channel.
-
Established senior-level relationships across national and regional commercial payers, PBMs, Medicaid plans, Medicare / MACs and IDNs.
-
Working knowledge of buy-and-bill economics, specialty pharmacy distribution, J-code / HCPCS coding, prior authorization workflows, and medical policy development.
-
Strong analytical skills, including the ability to interpret HEOR, budget impact, and value-based contracting models.
-
Executive presence and the ability to operate independently across senior external stakeholders.
Preferred Qualifications
-
Experience supporting a U.S. product launch in rare disease or advanced therapy.
-
Experience working with State and Managed Medicaid plans.
-
Prior cell or gene therapy payer engagement experience.
-
Experience operating in a pre-commercial or early commercial company with limited infrastructure.
Core Competencies
-
Strong problem-solving and decision-making ability.
-
Vendor management and negotiation skills.
-
Ability to work in a fast-paced, rapidly scaling environment.
-
Exceptional attention to detail and documentation discipline.
-
Ability to influence without authority across cross-functional teams.
Work Environment & Physical Demands
-
Field-based (remote) position based in or near the assigned territory; territory geography determined at time of hire.
-
Domestic travel approximately 50 to 75% for payer engagement, internal meetings, and industry conferences (AMCP, Asembia, PCMA).
-
Periodic presence at Capricor's San Diego HQ (approximately 2 to 3 times per quarter) or as required by business need.
