Director, Payer Relations

About Theranica:

Theranica is a prescription digital therapeutics company developing advanced, drug-free electroceuticals for idiopathic pain conditions. Its flagship product, Nerivio, is an FDA-cleared, smartphone-controlled wearable that uses remote electrical neuromodulation (REN) for the acute and preventive treatment of migraine. Theranica has secured coverage for more than 160 million health plan members, including the largest U.S. insurer, and is building the payer, distribution, and reimbursement infrastructure needed to make Nerivio accessible to every appropriate patient.

Position Summary:

The Director, Payer Relations leads Theranica’s upstream payer strategy: winning and expanding favorable coverage policy for Nerivio across national, Blue Cross Blue Shield, and other regional payers. This leader owns relationships with the medical directors, pharmacy directors, clinical policy teams, and technology assessment committees who decide whether Nerivio is covered, and turns clinical and economic evidence into written policy.

Coverage policy is only the first step toward a paid claim. This role works hand-in-hand with the downstream Market Access, Payer Contracting, and Field Reimbursement teams so that every policy win becomes contracted access, clean claims, and patients on therapy, and uses downstream claims and denial data to decide where to push next.

Key Responsibilities:

1. Coverage and Medical Policy Strategy

• Build and execute a tiered, account-level coverage plan that ranks payers by covered lives, Nerivio prescription volume, denial exposure, and strategic value.
• Lead medical policy submissions, reconsideration requests, and policy reviews to move Nerivio from “experimental/investigational” or “not medically necessary” to covered status, including drafting proposed coverage criteria payers can adopt.
• Run policy surveillance: track medical and pharmacy policy updates, technology assessment committee calendars, and third-party assessments (e.g., BCBSA Evidence Street, Hayes, ECRI), and lead Theranica’s response to adverse changes.
• Shape benefit-category positioning across DME and pharmacy benefit channels with the Market Access and Payer Contracting leads.

2. Payer Engagement and Relationships

• Build trusted relationships with medical directors, pharmacy directors, and clinical policy leaders at national plans (UnitedHealthcare, Elevance/Anthem, Cigna, Aetna/CVS Health, Humana), BCBS plans, and other regional plans.
• Map decision-makers, influencers, and review processes for each priority account, and keep stakeholder records current in the CRM.
• Lead clinical and economic presentations to payer committees and coordinate KOL and treating-physician participation in payer meetings.
• Represent Theranica at payer-focused industry meetings and managed care forums.

3. Evidence and Value Communication

• Partner with Medical Affairs and HEOR to develop and maintain the payer value dossier, budget impact model, and plan-specific fact sheets and leave-behinds.
• Translate clinical trial and real-world evidence (e.g., reduced acute medication use and migraine-related healthcare utilization) into concise, payer-relevant value messages.
• Identify the evidence gaps that block coverage and feed them into Theranica’s evidence generation plan.

4. Advocacy and Cross-Functional Collaboration

• Partner with Patient Advocacy on HCP sign-on letters, professional society engagement (e.g., American Headache Society, AAN), and patient voice campaigns that support coverage decisions and reimbursement adequacy.
• Hand off policy wins to Payer Contracting and Market Access for contracting, distributor alignment, and implementation, and use claims, denial, and distributor data to set upstream priorities.
• Equip Field Reimbursement and Sales with coverage maps, policy updates, and field communications so the field can act on wins quickly.
• Contribute to Market Access planning forums, including script-journey reviews that address friction points and patient leakage.

5. Performance and Reporting

• Own upstream KPIs: net-new covered lives, positive policy decisions, time to decision, and policy-driven reductions in denials.
• Report progress, risks, and payer intelligence to the VP, Market Access and the executive team.
• Manage the payer engagement budget, including external consultants and dossier development.

Qualifications:

Required

• Bachelor’s degree required; MBA, MPH, MHA, PharmD, or clinical degree preferred.
• 10+ years of healthcare industry experience, including 5+ years in payer relations, market access, or managed care account leadership for medical devices, digital therapeutics, or specialty pharmaceuticals.
• Proven record of securing positive medical policy for a novel technology, ideally moving a product from experimental/investigational to covered.
• Established relationships with medical and pharmacy directors at national and regional health plans, including BCBS plans.
• Deep knowledge of payer coverage processes: medical policy development, technology assessment, DME and pharmacy benefit design, utilization management, and Medicaid managed care.
• Working knowledge of HCPCS/CPT coding, DME reimbursement, fee schedules, and CMS/DME MAC policy.
• Ability to turn complex clinical and health economic evidence into clear, persuasive payer messaging.
• Excellent presentation, negotiation, and executive communication skills.

Preferred

• Experience in neurology, headache/migraine, or pain management.
• Experience with DME channel strategy or dual-benefit products.
• Experience building payer access at an early commercial-stage company.
• Prior health plan experience in medical policy, clinical programs, or technology assessment.
• Strategic thinking. Sees the full path from policy to paid claim and prioritizes accordingly.
• Relationship leadership. Earns credibility with physician and pharmacist decision-makers.
• Evidence fluency. Reads, critiques, and communicates clinical and economic data with confidence.
• Cross-functional influence. Aligns Advocacy, Contracting, Field, Medical, and Sales around shared coverage goals.
• Ownership and urgency. Moves quickly, tracks results, and adjusts based on data.

Theranica is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law.