Jobs at Prime Therapeutics

Manages regulatory and client-initiated audits for a pharmacy benefit manager. Reviews audit scopes, coordinates stakeholders, gathers evidence, monitors progress, identifies risks, reviews deliverables, maintains audit records, communicates findings, and recommends remediation. The role also leads audit strategy, milestones, accountability, and process enhancement initiatives while ensuring compliance with contractual, regulatory, and accreditation requirements.

Manage sourcing for lower-risk, lower-spend vendor categories: develop sourcing strategies, run RFx/RFP events, negotiate and redline contracts, support vendor lifecycle management, produce spend and performance reports, and maintain procurement system data and sourcing process improvements.

Senior infusion nurse who coordinates lower-cost sites of service for oncology drug infusions, educates members/providers on financial impacts, documents cases, validates prior authorizations, supports copay assistance, and maintains caseloads to optimize treatment outcomes and reduce overall healthcare costs.

Coordinate and support infusion referrals to transition members to lower-cost treatment sites, educate members/providers on financial impacts, assist with copay programs, validate prior authorizations, document cases in web-based systems, and apply clinical knowledge to optimize treatment outcomes while maintaining an active caseload.

Serve as the primary clinical account lead for assigned customers, driving pharmacy program value, contract compliance, financial performance, and customer satisfaction. Build strategic plans, manage account teams, support clinical operations and implementations, identify upsell opportunities, and ensure SLA and claims accuracy while managing P&L and talent development.

Lead sourcing strategies for mid-risk, mid-spend, complex vendor categories. Manage RFx/RFPs, vendor selection, negotiations, contract drafting/redlining, and supplier lifecycle. Partner cross-functionally to drive cost savings, performance, risk reduction, and sourcing system improvements. Mentor team members and support sourcing projects and policy initiatives.

Lead actuarial pricing, modeling, and data analyses for PBM clients. Provide strategic pricing advice, manage complex projects, mentor actuarial staff, present findings to stakeholders, and ensure regulatory and actuarial standards compliance.

The Senior Analyst - Pharmacy Pricing performs pharmacy pricing analyses, analyzes data trends, partners with teams for accurate outputs, and improves processes.

Lead and execute medium-sized projects as a liaison among business, technology, clients, and vendors. Elicit, document, and manage requirements, assess solution options, plan BA activities including UAT, ensure requirements traceability, and advance BA best practices across the organization.

Provide tactical HR support to employees, supervisors and managers. Manage employee relations, coach managers on performance and disciplinary actions, partner with Talent Acquisition, assist with job descriptions and compensation reviews, drive performance appraisal processes, participate in HR projects, and handle other HR duties as assigned.

Lead client-facing initiatives for employer groups, resolve complex issues, drive process improvements, support implementations and reporting, mentor account team, document interactions in Salesforce, and promote Prime products to optimize pharmacy spend and retention.

Lead product analysis and delivery for solution products within an Agile Product Team. Collaborate with product owners, engineers, and QA to refine epics, write and decompose user stories, validate designs, produce UI/UX mock-ups, and support deployments. Mentor team members, facilitate demos and iterative reviews, and ensure solutions meet KPIs, compliance, and business value.

Manage development and contracting of Prime's retail, mail, specialty and quality-based pharmacy networks. Negotiate pharmacy agreements, run contracting campaigns, analyze network adequacy and performance, support audits and cross-functional projects, ensure regulatory and contractual compliance, and maintain provider relationships with chains, PSAOs and independents.

Lead regulatory assessments, external audits, and accreditation activities for Commercial, Medicare, Medicaid, and Marketplace programs. Act as primary contact for clients, auditors, and accreditation reviewers; manage gap reporting, SOP maintenance, change management, and responses to compliance inquiries; participate in regulatory committees and CMS calls.

Provide physician-level utilization management reviews for psychiatry service requests, discuss decisions with ordering providers, document communications, support initial reviewers, participate in inter-rater reliability training, assist Medical Director with research and appeals, and occasionally serve as Medical Director for select plans.

Lead enterprise implementations, migrations, and customer success for major client migrations (Judi Health). Own program strategy, governance, budgets, cross-functional alignment, executive reporting, risk escalation, and measurable outcomes while driving continuous improvement and client satisfaction.

Lead strategic and operational oversight of pharmacy claims adjudication, benefit configuration, and network operations. Drive modernization, ensure compliance and accuracy, manage cross-functional teams, measure performance, reduce risk, and develop organizational capability to deliver client-focused outcomes.

Lead clinical account activities for PBM clients, mentor clinical liaisons, drive adoption of clinical solutions, manage account P&L and revenue goals, coordinate implementations, track program metrics, and collaborate across departments to improve care and reduce costs for Medicaid populations.

Research and resolve complex or escalated member issues with compliant, accurate documentation and communications. Act as SME guiding research strategies, validate casework, determine escalations, support reporting, process improvements, and operational performance monitoring.

The AVP of Underwriting leads pricing strategies and client consultations, managing a team to develop competitive pricing and contract language for employer pharmacy business.