National Account Director, Government Payers —Medicaid

Overview of Role: 

The National Accounts Director, Government Payers –Medicaid will be responsible for leadership and management of Fee-for-Service Medicaid, Managed Medicaid, and Medicaid Buying Pools and other assigned accounts. This is a critical customer-facing role helping to ensure broad access, reimbursement, and patient affordability.    

The Director will be responsible for building and maintaining strong relationships with decision makers within the accounts, including medical and pharmacy departments. This role involves executing strategies and tactics within each account, while also providing support to the regional field matrix teams when necessary.  A strong understanding of managed markets, reimbursement, and payer account management is essential.   

 

Role and Responsibilities: 

Medicaid — Fee-for-Service and Managed Medicaid   

• • Establish and maintain relationships with key decisionmakers, including P&T, Medical and Pharmacy Director, and population-based stakeholders to secure appropriate access and optimal product positioning.   
  • Build the state Medicaid access strategy across fee-for-service programs, Medicaid managed care organizations, and single preferred drug list states, prioritizing oncology volume, coverage restrictiveness and state dynamics.  
  • Navigate state-level utilization management: prior authorization criteria, step edits, preferred drug lists, P&T committee submissions, and state Drug Utilization Review boards. 
  • Address physician-administered drug billing requirements at the state level, including NDC-to-HCPCS crosswalk requirements and state-specific claims mechanics that create access friction for buy-and-bill products.  
  • Monitor Medicaid policy developments — state budget pressure, supplemental rebate arrangements, multi-state purchasing pools, and the Medicaid managed care carve-in/carve-out landscape for oncology drugs.  

Cross-Functional Leadership  

• • Partner with field reimbursement and patient services teams to design the support infrastructure — benefits investigation, prior authorization support, denial and appeals resources — that Medicaid patients will require at launch.  
  • Partner with HEOR and Medical Affairs to define the evidence government payers will require, including real-world evidence and economic analyses relevant to Medicaid populations, P&T, DUR Reviews.  
  • Assist Regional Sales teams with pull-or-sell through strategies based on payer coverage.   
  • Lead discussions with internal and external partners to ensure alignment on access, coverage, and reimbursement strategies.   
  • Foster a high-performance culture within the field team by promoting accountability, urgency, ethical behavior, and professional development.  

Compliance  

• • Conduct all activities in strict accordance with the Anti-Kickback Statute, the False Claims Act, FDA promotional regulations, government price reporting requirements, the PhRMA Code, and Summit's compliance policies. 
  • All other duties as assigned. 

 

Experience, Education and Specialized Knowledge and Skills: 

• Bachelor's degree required; MBA, PharmD, or other advanced degree preferred.  
• Minimum 10+ years of biopharmaceutical experience, with at least 5+ years in government payer, reimbursement, or policy roles.  
• Minimum of 5+ years in Oncology or immuno-oncology account management experience.   
• Demonstrated success in engaging with US Payers  
• Strong understanding of the US healthcare payer/access landscape and regulatory environment  
• Excellent strategic thinking, leadership, negotiation, and relationship management skills  
• Ability to work with cross-functional teams and drive complex projects to completion  
• Exceptional communication and presentation skills  
• Ability to travel up to 50% to support business priorities as needed  
• Working knowledge of the Medicaid Drug Rebate Program, AMP/Best Price mechanics, and state Medicaid utilization management.  
• Experience launching a buy-and-bill specialty or oncology product into the U.S. government payer channel.  
• Ability to interpret regulation and translate it into commercial strategy for non-technical audiences.  
• Successful record of achieving and maintaining compliance with all applicable regulatory, legal, and operational rules.  
• The ability to work effectively in a fast-paced and dynamic environment, balancing multiple priorities and meeting deadlines.  
• Preferred Qualifications include: 
  • Oncology Buy & Bill launch experience, particularly through the transitional coding period.  
  • Prior experience working with Medicaid  
  • Experience building a government payer function at a pre-commercial or newly commercial company.