Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Education & Outreach Provider Educator
Job Description Summary
Ensures providers and prescribers are aware of Plan policy and requirements for claims submissions and/or prior authorization (PA) requests. Conducts outbound calls and visits to prescribers or pharmacy providers who need assistance, or for proactive outreach. Travel may be required and varies by client. Additional responsibilities include reporting, letter preparation, and other duties to assist the Pharmacist Account Executive (PAE) or Clinical Account Manager in providing support to the client.
Job Description
- Supports provider outreach for planned clinical activities through letter preparation and tracking.
- Supports outcomes reporting for various projects.
- Serves as the company`s representative in the field and effectively communicates with providers about company policies, procedures, contractual requirements, and other issues.
- Works with Clinical Account Manager (or PAE) to draft, clarify, and recommend changes to policies that have an impact on network management and clinical outcomes.
- Evaluates provider compliance with company policies and procedures as well as with clinical and administrative standards required by the client.
- Provides issue resolution and complex trouble shooting skills to providers, acting as the liaison between the company, the Plan, and the provider community, with the goal to reach satisfactory results without the need for client intervention.
- Supports the Clinical Account Manager (or PAE) in providing trends reporting and evaluating claims for outlying providers who may have issues or irregular habits as it relates to pharmacy claims submission or prescribing.
- Conducts and evaluates provider educational activities.
- Designs and develops provider training and educational materials, and the planning and coordination of provider meetings, seminars, and conferences.
- Reports activities and results to the client, seeking feedback for future planned outreach.
Responsibilities
- Bachelor's degree with a minimum of three years' pharmacy or other healthcare experience.
- An equivalent combination of experience and education will be considered.
- Proficiency with Microsoft Office.
- Excellent written and verbal communication skills.
- Strong organizational skills.
Work Experience
Work Experience - Required:
Healthcare, Pharmacy
Work Experience - Preferred:
Education
Education - Required:
A Combination of Education and Work Experience May Be Considered., Bachelors - Healthcare
Education - Preferred:
Certifications
Certifications - Required:
Certifications - Preferred:
CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy - Pharmacy
Potential pay for this position ranges from $43,190.00 - $64,770.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.
Positions will be posted for a minimum of five consecutive workdays.
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What We Do
Everything we do is connected to helping people get the medicine they need to feel better and live well. It’s meaningful work and we’ve been doing it for over 20 years. In the pharmacy benefit management (PBM)industry, we’re different. We’re owned by 18 not-for-profit Blue Cross and Blue Shield health plans. This allows us to control costs and empower our employees to put members first. It’s a successful combination. We have the lowest pharmacy trend in the industry and serve 28+ million members throughout the US. In addition to core PBM services, we work closely with our clients to implement the right benefit design, clinical and specialty programs, formulary and networks. A few key products: • NetResults™ • Specialty Drug Management • Best in Care™ • GuidedHealth® • Advanced Fraud, Waste and Abuse: Member and Prescriber Investigations • Prime Analytics™ • CareCentered Contracting™Controlled Substance Management Program Join us! Prime is always looking for smart, purposeful people to join our team. We’re growing fast which means there are plenty of opportunities to advance and grow in your career. At the same time, Prime supports flexibility and offers generous PTO so you can enjoy an enviable work/life balance. We’re a privately held company -big enough to make a difference and small enough for you to have an impact. Follow Prime on LinkedIn to learn more.
