Director / Senior Director, Head of Patient Access & Reimbursement

About Capricor Therapeutics

Capricor Therapeutics is a biotechnology firm focusing on innovative cell and exosome-based therapies for rare diseases. Their lead product, Deramiocel (CAP-1002), is in late-stage development targeting Duchenne muscular dystrophy. Utilizing their proprietary StealthX™ exosome platform, they are exploring novel approaches in targeted delivery and vaccines, committed to advancing treatments that significantly impact patients' lives.

Role Overview

The Director / Senior Director is responsible for collaborating with internal stakeholders and external partners to ensure smooth patient access to Capricor's approved therapies. This role involves assembling and guiding a strategic partner field team dedicated to site of care activation and operational readiness, facilitating patient referrals, and coordinating product distribution to enhance provider and patient experiences.

Key Responsibilities

• Lead and develop a regionally aligned Patient Access & Reimbursement field team, including hiring and training.
• Work with cross-functional commercial leadership to define team roles and workflows.
• Provide reimbursement education to healthcare providers and sites, supporting patient access for Duchenne muscular dystrophy families.
• Set access goals and productivity metrics, oversee account planning and execution.
• Collaborate with teams to track patient prescriptions and resolve access issues promptly.
• Foster continuous learning and identify process improvements with third-party providers.
• Support analytics to inform forecasting, pricing, contracting, and business planning.
• Engage with healthcare sites to assess capabilities, address operational gaps, and assist during formulary and site readiness processes.
• Reduce barriers to patient access and reimbursement across all payers and help manage patient support services including referral management and affordability assistance.
• Develop training materials and ensure sites understand procurement, reimbursement, and authorization procedures.
• Partner with sales and compliance to identify and address access challenges, providing leadership updates and participating in key business reviews.
• Maintain awareness of market competition affecting access strategies and build relationships with advocacy groups and key opinion leaders to promote awareness.
• Serve as an expert on access, reimbursement, distribution, and payer coverage, supporting corporate training and content creation.
• Represent Capricor at relevant industry conferences.
• Uphold high ethical standards and company values in all activities.

Requirements

• Bachelor's degree required; preferred fields include sciences or business. Advanced degrees (MBA or higher) are a plus.
• At least 10 years in biopharma or healthcare services, including sales, reimbursement, patient support, or market access.
• Minimum 5 years' progressive experience with patient support, payer and specialty pharmacy operations, and case management.
• Strong leadership background managing self-directed teams.
• Experience with rare/orphan drugs is essential; pediatric infused drugs and therapeutic launch experience preferred.
• Expertise in reimbursement, coding, claims, authorizations, appeals, and provider education.
• Comprehensive knowledge of specialty pharmacy, buy-and-bill models, payer policies, and healthcare access dynamics.
• Understanding of provider economics, hospital finance, revenue management, and infusion site operations.
• Familiarity with HIPAA and OIG compliance in rare disease contexts.
• Experience with billing, coding, and claims processing is advantageous.
• Skilled in patient support programs including financial assistance and adherence initiatives.
• Strong grasp of prior authorization, denial management, product acquisition channels, and reimbursement at various care sites.
• Adaptable problem solver able to lead projects and implement innovative solutions.
• Excellent interpersonal, communication, analytical, and presentation abilities.
• Budget management experience to effectively allocate resources for patient support goals.
• Business acumen with strong compliance orientation.
• Passionate about patient-centered care and commercial organization growth.
• Proficient in virtual communication tools and Microsoft Office suite.

Supervisory Responsibilities

• Recruit, hire, and train new team members.
• Provide timely and constructive performance evaluations.
• Manage additional supervisory duties as assigned.

Core Competencies

• Problem-solving and effective decision-making capabilities.
• Vendor management and negotiation skills.
• Continuous improvement of functional tools and processes.
• Ability to thrive in a fast-paced, scaling environment.
• Meticulous attention to detail and documentation.
• Influential collaboration across cross-functional teams.

Work Environment and Travel

• Role is primarily remote but requires office visits in San Diego, CA approximately 2-3 times per quarter or as needed.
• Up to 50% domestic travel anticipated based on business demands.

Additional Information

Capricor Therapeutics is devoted to advancing therapies for serious conditions in a mission-driven, collaborative culture. Employees are encouraged to contribute, grow, and help build foundational systems to support organizational growth.

Recruiting Notes: Official communications will only come from Capricor email addresses ending with @capricor.com. The company does not request any form of payment during recruitment or onboarding. Unapproved recruiting agencies or submissions are not accepted.

Compensation: Salary ranges are an estimate based on factors like experience, education, and role scope. Performance bonuses and equity incentives may be awarded depending on role level.