Capricor Therapeutics (NASDAQ: CAPR) is a biotechnology company dedicated to advancing transformative cell and exosome-based therapies for rare diseases. At the forefront of our innovation is Deramiocel (CAP-1002), our lead cell therapy in late-stage development for Duchenne muscular dystrophy. We are also harnessing our proprietary StealthX™ exosome platform to unlock new possibilities in targeted delivery and vaccinology. Every program reflects our commitment to pushing the boundaries of science and delivering life-changing treatments to patients and families who need them most.
The Senior Director, Field Reimbursement will build and lead Capricor's U.S. field reimbursement team in support of the anticipated launch of deramiocel, Capricor's lead cell therapy for Duchenne muscular dystrophy. The role is responsible for designing the field reimbursement model, hiring and leading the Patient Engagement & Reimbursement Liaison team, and making sure prescribers, treatment centers, and families get timely, compliant support from benefits investigation through prior authorization, appeals, and treatment. This leader partners closely with Trade & Patient Services, Payer Strategy & Engagement, the hub vendor, National Account Directors, Sales, Infusion Site Nurse Educators, Medical Affairs, Legal, and Compliance.
Field Reimbursement Strategy & Model
Design the U.S. field reimbursement model for deramiocel, including territory alignment, team size, engagement rules, and launch sequencing.
Build site-of-care readiness plans with treatment centers and infusion sites across buy-and-bill, specialty pharmacy, and medical-benefit pathways for an infused cell therapy.
Translate payer coverage policies and coding guidance, including HCPCS and ICD-10, into field tools and training in partnership with Payer Strategy & Engagement.
Hub, Patient Services & Case Escalation
Partner with Trade & Patient Services to set the operating model between the field team and the hub vendor, including referral flow, case handoffs, and escalation paths.
Serve as the escalation point for complex benefits investigations, prior authorizations, denials, and appeals.
Hold the hub vendor and specialty pharmacy partners to agreed SOPs, service levels, and KPIs.
Account Education & Field Insights
Lead the team's education of prescribers, treatment-center staff, and families on access pathways, support programs, and the treatment journey.
Establish account plans, productivity measures, and field cadence for the Liaison team.
Capture field insights on access friction, payer trends, and family experience, and report them to Market Access and Commercial leadership.
Operations & Compliance
Own field reimbursement SOPs, documentation standards, CRM use, and the field reimbursement budget.
Ensure all field reimbursement activity follows Capricor compliance standards, including FDA, OIG, PhRMA Code, HIPAA, and the firewall between patient services and promotional activities.
Represent Capricor at key patient access and patient services conferences (e.g., Asembia).
Perform other duties as assigned.
Bachelor's degree required; advanced degree (MBA, MPH, or related) preferred.
10+ years of biopharmaceutical experience, including 5+ years in field reimbursement, patient access, or market access roles.
4+ years leading a field reimbursement or patient access team.
Rare-disease or specialty launch experience required.
Hands-on knowledge of medical-benefit reimbursement, buy-and-bill, specialty pharmacy, prior authorization, appeals, coding, and hub services.
Strong working knowledge of HIPAA, OIG guidance, and the Anti-Kickback Statute as applied to field reimbursement and patient services.
Demonstrated ability to build processes and teams in a launch or rapidly scaling environment.
Directly leads the Patient Engagement & Reimbursement Liaison team supporting the U.S. treatment-center footprint.
Recruits, coaches, develops, and manages the performance of field reimbursement staff, including regular field time with each team member.
Owns territory design, workload planning, training, and staffing to support launch readiness and post-launch scale.
This team will expand as the business scales; the Senior Director will lead future hiring and organizational development.
Cell or gene therapy field reimbursement or patient services experience.
Neuromuscular, DMD, or pediatric rare-disease experience, including engagement with families and treatment centers.
Experience standing up a field reimbursement team at launch.
Established relationships with DMD treatment centers, infusion sites, and specialty pharmacies.
Experience selecting and managing hub, specialty pharmacy, or field nurse vendors.
Strong problem-solving and decision-making ability.
Vendor management and negotiation skills.
Ability to work in a fast-paced, rapidly scaling environment.
Exceptional attention to detail and documentation discipline.
Ability to influence without authority across cross-functional teams.
Field-based (remote) position; expected to be in the San Diego, CA office approximately two to three times per quarter, or as required by business need.
Domestic travel approximately 50 to 60% for field coaching, treatment-center engagement, conferences, and internal meetings.
Extended periods of computer-based work, including video conferencing and collaborative software platforms.