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Sr. Director, Health Economics & Outcomes Research & Payer Policy

  • United States
  • Full Time

About the Job

The Senior Director, Health Economic Outcomes Research (HEOR) & Payer Policy leads analyses of real-world biomedical data with a focus on the clinical utility of next-generation sequencing, the impact of diagnostics on patient care, and cost to the healthcare ecosystem. Analyses is conducted using Foundation Medicine’s growing repository of molecular information as well as external data sources, including payer claims data and other EMR databases matched with FMI data, to execute on the payer data analysis plan.

This position leads and drives and manages payer-related data initiatives in partnership with departments within the organization as well as external vendors, including contributions to the strategy of the overall payer HEOR data generation plan, development of statistical analysis plans, execution of data analysis, review of statistical analysis plans from outside vendors, and writing manuscripts for publication. This position will lead the evidence generation strategy and tactical execution of plans to drive timely and optimal access and reimbursement

Key Responsibilities

  • Sets direction and leads cross-functional teams on development of health economic, value messaging, reimbursement and coverage strategies based on robust understanding of physicians, business/practice managers, payers, and their decision-making systems.
  • Provides strategic direction and leadership to cross-functional teams to develop and execute on HEOR Plans and strategies.
  • Ensures timely and quality HEOR deliverables (studies, publications, dossiers, government responses, sales and education tools) that support development of strong value propositions for FMI products.
  • Provides strategic direction and customer perspective on development of internal/external coding/coverage/reimbursement strategies, education, tools and support.
  • Provides strategic direction on economic buyer and commercial payer-related issues related to reimbursement, coverage, and contracting for the division product portfolio.
  • Works in close collaboration with Market Access, Payer Strategy & Strategic Accounts’ teams.
  • Works in close collaboration with Digital and Market Access to generate insights from RWD and to set up RWE programs to optimize reimbursement
  • Sets the strategy on the value of companion diagnostics and in differentiating FMI products from the competition through insights, data, analysis, and compelling evidence
  • Liaise with Government Affairs, Physician societies, Patient Organizations and other corporate organizations to ensure support for health policy and market access activities.
  • Communicates with senior management members and departments necessary in order to facilitate achievement of reimbursement and assess objectives.
  • Leads internal platform meetings to influence and provide strategic guidance on the required evidence to differentiate as well as reporting customers’ insights to R&D and Medical Affairs
  • Manages key relationships with HTA bodies, providers, payors, international reimbursement teams as appropriate.
  • Support each customer group in a manner that reflects their needs and expectations of the business partnership and working with internal cross-functional teams to communicate the division value proposition.
  • Set direction for communication strategies to keep internal management regularly informed about coding/coverage/reimbursement issues affecting the company and its customers.
  • Sets direction for outside vendor relationships and projects. Represents FMI externally.
  • Participates and leads key strategic product cross-functional teams on what? On customer feedback and insights on products and services and competitions’ areas of strength
  • Develop strong teams, foster a collaborative work environment and culture, encourage innovative thinking, and build leadership skills of direct reports and team members.
  • Serve as a strong change agent for and within the Commercial organization, setting the standard and role modeling exceptional change leadership and communication practices.
  • Strive for excellence in all aspects of performance, including continuous self-evaluation and development.
  • Ability to work independently
  • Other duties as assigned.


Basic Qualifications

  • Bachelor’s Degree from a 4-year institution
  • 12+ years of experience in healthcare industry (diagnostics, medical device)
  • 12+ years of experience in health economics and outcomes research including budgetary impact, cost-effectiveness, cost-utility analyses, prospective studies, real world evidence studies, and claims database analysis; 6+ years of progressive leadership experience
  • 5+ years of experience managing a team of people managers

Preferred Qualifications

  • Advanced Health Care degree PhD, MS/MPH, MD, or PharmD
  • Broad knowledge of government and private payer reimbursement in the US and outside-US markets and understanding of the health care policy
  • Knowledge of both US and international health care systems
  • Knowledge of health economics and outcomes research, reimbursement, coverage, coding and payment mechanisms in the US and globally is highly desirable
  • Knowledgeable about product development process (R&D), collaboration with biopharma, regulatory approvals as well as commercialization
  • Experience:
    • working with KOLs, as well as government and private payers
    • writing manuscripts, medical policies, dossiers, etc.
    • working with hospital administrators/economic buyers at all levels, and health plan, managed care and/or physician group payers
    • in gaining payor coverage decisions and developing payer coverage policies desirable
    • in leading cross-functional teams required
    • influencing many levels of the organization and a variety of different groups including marketing, regulatory, sales, legal, clinical, medical affairs and project management
    • building global/ regional dossiers
  • History with direct analysis of health care clinical, health economic and outcomes data to support clinical, administrative and/or market development, health policy and publication strategy initiatives
  • Creative ability to develop innovative programs and to develop novel methodologies for economic analyses applied to the device industry
  • Understanding of health policy and the importance of timely strategies needed to anticipate and influence coverage decisions, technology assessments and impact market expectations
  • Ability to design and conduct of systematic literature reviews; retrospective and prospective research experience
  • Understanding the principals and practical application of value-based pricing and product access
  • Proven ability to translate technical data into commercial strategies
  • Strong ability to make effective decisions independently while working in a matrix and off-site environment
  • Strong team player and motivator
  • Decisive and quick thinker; able deal with abstract concepts and handle ambiguity well
  • Willing to travel up to 30%
  • Understanding of HIPAA and importance of privacy of patient data
  • Excellent verbal and written communication skills
  • Effective presentation skills
  • Ability to work independently with minimal supervision
  • Negotiation skills
  • Ability to prioritize and make effective decisions and manage uncertainties
  • Strategic and critical thinker
  • Commitment to FMI values: patients, innovation, collaboration, and passion



Please be aware that Foundation Medicine mandates COVID-19 vaccination of all employees regardless of work location. Accommodations may be made in accordance with applicable law.


About Foundation Medicine

Foundation Medicine, Inc. (FMI) began with an idea—to simplify the complex nature of cancer genomics, bringing cutting-edge science and technology to everyday cancer care. Our approach generates insights that help doctors match patients to more treatment options and helps accelerate the development of new therapies. Foundation Medicine is the culmination of talented people coming together to realize an important vision, and the work we do every day impacts real lives.

Confidence, or the belief that we need to check every box before applying for a job, can sometimes hold us back from going after a role that inspires us. At Foundation Medicine there's no such thing as the 'perfect' applicant, and our company is a place where every employee can make an impact and continue to grow whatever background they may have or path they may have taken. So, as long as you meet the basic qualifications for a role, please apply if you see a position that would make you excited to come into Foundation Medicine every day and help us transform cancer care.

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Foundation Medicine is proud to be an Equal Opportunity and Affirmative Action employer and considers all qualified applicants for employment without regard to race, color, religion, sex, gender, sexual orientation, gender identity, ancestry, age, or national origin. Further, qualified applicants will not be discriminated against on the basis of disability or protected veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. See also FMI’s EEO Statement and EEO is the Law and Supplement. If you have a disability or special need that requires accommodation, please let us know by completing this form.  (EOE/AAP Employer)

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