Jobs at Prime Therapeutics

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.

Support client operations by posting payments, mailing dunning letters, maintaining service agreements, assisting invoicing (pre-invoicing review) for multiple rebate programs, fulfilling client requests and supporting account/rebate management.

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

The Lead Actuary leads complex pharmacy pricing analyses, provides strategic guidance on pricing, mentors team members, and ensures compliance with regulations.

Provide tactical legal advice and contracting support to PBM, pharmacy, and government program clients; draft and negotiate commercial agreements; advise on regulatory compliance; provide legal training; coordinate with in-house and outside counsel; investigate and support account management functions.

Travel to pharmacies to perform onsite audits: select and schedule audits using claims analytics, validate claim documentation, identify erroneous claims, educate pharmacy staff on compliance, prepare audit reports, enhance audit tools, track audit data, and support claim corrections.

Perform pharmacy claim audits by analyzing large datasets and audit findings to identify high-risk claims, billing irregularities, and compliance issues. Select audit samples, evaluate claims and documentation against contracts and regulations, educate pharmacies on documentation and reimbursement corrections, and support audit projects and trend identification to reduce waste and ensure contract compliance.

Lead enterprise-wide Lean Six Sigma transformation initiatives, advise senior leaders on future-state operating models, govern continuous improvement standards, drive measurable financial and operational outcomes, and mentor process improvement practitioners. Use data analysis, statistics, and visualization to identify root causes, measure impact, and sustain benefits across the organization.

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.

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

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.

Performs all functions of a registered pharmacist including verifying and processing specialty medication orders, counseling patients and healthcare providers, maintaining pharmacy records, and participating in on-call rotation. Ensures compliance with federal/state laws and company policies, completes required training, and maintains clinical knowledge through continuing education.

Lead state and federal policy strategy for PBM regulatory and legislative matters. Advise executive leadership, produce policy materials, manage advocacy and federal comment filings, represent the company externally, and coordinate cross-functional stakeholder engagement.

Lead development and execution of oncology product initiatives across commercial and government business units. Manage multiple complex products end-to-end, perform market and financial analysis, set pricing, create value stories and launch plans, collaborate cross-functionally, present to senior management, and support client training and marketing collateral.

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.

Lead analysis and compliance for claim payments, escheatment, and prompt-pay laws. Manage issue triage, support implementations, drive process improvements, and provide guidance to junior staff while collaborating across Accounting, Finance, IT, Claims, Pharmacy Networks, and Government Programs.

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.