Senior Manager, Upstream Reimbursement Strategy

Job description

Primary Function of Position The Upstream Reimbursement Strategist is the architect of the organization’s long-range reimbursement and market access strategy across the U.S. product portfolio. This person is responsible for generating all strategies for all upstream programs and dovetailing those strategies with global market access for ex-U.S. projects. This role is the closest link to the clinical development team and serves as the primary strategic interface with HEOR, regulatory affairs, and health policy stakeholders. Responsible for evidence generation strategy, CPT/HCPCS code pathway design, CMS payment policy analysis, and the global coordination of evidence that feeds both upstream regulatory submissions and downstream field execution tools. This person shapes the narrative for why a product deserves reimbursement and builds the data package to support it. This role carries shared responsibility for midstream activities (code acquisition, pre-launch payer engagement) until a dedicated Midstream hire is made (18 months). The strategic upstream work evidence, coding pathways, payment policy, is the primary focus. Responsibilities Reimbursement Evidence Strategy: Partner with HEOR to design, commission, and oversee health economic and outcomes research studies that support reimbursement across the product portfolio. Ensure evidence generation aligns with regulatory, payer, and provider needs. Reimbursement Data Collection: In coordination with HEOR, architect the evidence plans for a reimbursed product. Oversee collection of that data and packaging into publications (e.g., burden of illness, cost-utility, budget impact) for payer and provider consumption, aligned with the broader payer and provider engagement campaign. CPT/HCPCS Code Strategy: Lead the strategy for new code applications, Category III code conversions, and descriptor modifications. Manage engagement with AMA CPT Editorial Panel, RUC, and HCPCS workgroups. CMS Payment Policy Analysis: Conduct ongoing analysis of OPPS, PFS, and ASC payment policy. Prepare and submit CMS comment letters during rulemaking cycles. Monitor NT-APC, pass-through, and device payment category developments. Global Evidence Coordination: Serve as the connective tissue between U.S. evidence needs and global HEOR and OUS markets. Dovetail U.S. upstream strategies with global market access to ensure alignment on ex-U.S. projects. Ensure evidence generation is sequenced to serve both U.S. regulatory/payer needs and ex-U.S. HTA submissions, coordinating timing and deliverables across jurisdictions. Coverage & Reimbursement Strategy: Generate and own the reimbursement strategy for all upstream programs across the full product portfolio. Develop and maintain the strategic reimbursement roadmap from early pipeline through commercialization, including target product profiles (TPPs) and core value dossiers (CVDs) for pipeline assets. Identify coverage gaps, analyze competitive reimbursement positioning, recommend pathway strategies, and ensure strategic continuity as products progress through development milestones. U.S. Value Plan Implementation Support: Play a supporting role to HEOR in ensuring the U.S. Market Access team has secured the database resources required to execute strategy and implement the recommendations set out in the U.S. Value Plan. Competitive Intelligence: Monitor competitor reimbursement strategies, code applications, pass-through approvals, and coverage determinations. Translate competitive intelligence into actionable strategic recommendations. Product Positioning & Message Alignment: Serve as the primary owner of product positioning in coordination with select downstream stakeholders, ensuring messaging is consistent across other stakeholders in the organization ,particularly when producing publications such as burden of illness, cost-utility, and budget impact analyses. Stakeholder Interface: Serve as the primary reimbursement strategy interface with clinical development, medical affairs, and regulatory affairs. Advise on trial design considerations that support future reimbursement endpoints. Market Access Research: Lead market access research to support value messaging, including claims analyses and where needed coordination of payer interviews, provider interviews, and other primary research. Payer Insights & Advisory Boards: Lead early payer advisory boards and simulated HTA exercises (e.g., NICE, ICER) to pressure-test clinical and economic evidence packages pre- filing, and translate insights into evidence and positioning adjustments. Shared Midstream Responsibility: Until a dedicated Midstream hire is made, contribute to code acquisition execution, pre-launch payer engagement planning, and payment policy implementation activities in partnership with the Mid/Downstream Tactician. Required Qualifications 4 year degree. A health policy degree or similar is a big plus 8+ years of progressive experience in medical device market access, health economics, reimbursement strategy, or related field Deep working knowledge of CMS OPPS/PFS/ASC payment systems, APC mechanics, and facility payment methodology Experience with CPT code applications, AMA Editorial Panel processes, and HCPCS coding pathways Demonstrated expertise in evidence generation, RWE study design, and health economic modeling Strong analytical skills with experience interpreting claims data, cost reports, and CMS rulemaking documents Ability to work cross-functionally with clinical, regulatory, HEOR, and commercial teams Preferred Excellent written and verbal communication skills; ability to translate complex policy into strategic recommendations Advanced degree (MPH, MBA, or equivalent; PhD or PharmD also welcome) Familiarity with healthcare data platforms Familiarity with HEOR models Due to the nature of our business and the role, please note that Intuitive and/or your customer(s) may require that you show current proof of vaccination against certain diseases including COVID-19. Details can vary by role. Intuitive is an Equal Opportunity Employer. We provide equal employment opportunities to all qualified applicants and employees, and prohibit discrimination and harassment of any type, without regard to race, sex, pregnancy, sexual orientation, gender identity, national origin, color, age, religion, protected veteran or disability status, genetic information or any other status protected under federal, state, or local applicable laws. Mandatory Notices U.S. Export Controls Disclaimer: In accordance with the U.S. Export Administration Regulations (15 CFR §743.13(b)), some roles at Intuitive Surgical may be subject to U.S. export controls for prospective employees who are nationals from countries currently on embargo or sanctions status. Certain information you provide as part of the application will be used for purposes of determining whether Intuitive Surgical will need to (i) obtain an export license from the U.S. Government on your behalf (note: the government’s licensing process can take 3 to 6+ months) or (ii) implement a Technology Control Plan (“TCP”) (note: typically adds 2 weeks to the hiring process). For any Intuitive role subject to export controls, final offers are contingent upon obtaining an approved export license and/or an executed TCP prior to the prospective employee’s start date, which may or may not be flexible, and within a timeframe that does not unreasonably impede the hiring need. If applicable, candidates will be notified and instructed on any requirements for these purposes. We will consider for employment qualified applicants with arrest and conviction records in accordance with fair chance laws. Preference will be given to qualified candidates who do not reside, or plan to reside, in Alabama, Arkansas, Delaware, Florida, Indiana, Iowa, Louisiana, Maryland, Mississippi, Missouri, Oklahoma, Pennsylvania, South Carolina, or Tennessee. This position may be filled at a different job level than listed here depending on business need and/or on the selected candidate’s experience, knowledge and skills. Compensation will be based primarily on the job level at which the role is filled and the candidate’s qualifications, consistent with applicable law. We provide market-competitive compensation packages, inclusive of base pay, incentives, benefits, and equity. It would not be typical for someone to be hired at the top end of range for the role, as actual pay will be determined based on several factors, including experience, skills, and qualifications. The target compensation ranges are listed. It started with a simple idea: what if surgery could be less invasive and recovery less painful? Nearly 30 years later, that question still fuels everything we do at Intuitive . As a global leader in robotic-assisted surgery and minimally invasive care , our technologies—like the da Vinci surgical system and Ion —have transformed how care is delivered for millions of patients worldwide. We’re a team of engineers, clinicians, and innovators united by one purpose: to make surgery smarter, safer, and more human. Every day, our work helps care teams perform with greater precision and patients recover faster, improving outcomes around the world. The problems we solve demand creativity, rigor, and collaboration. The work is challenging, but deeply meaningful—because every improvement we make has the potential to change a life. If you’re ready to contribute to something bigger than yourself and help transform the future of healthcare , you’ll find your purpose here.