Prime Therapeutics

Network Engineer

• Negotiate market competitive high-profile and/or complex pharmacy agreements across all channels including retail, mail, and quality based and lines of business aligning with Supply Chain COGS strategies
• Lead and implement network initiatives by facilitating and performing network analyses, contracting activities and fee schedule development aligning with strategy, priorities and projects goals
• Partner with Prime's reporting and analytics teams to develop network vendor loading rules inclusive of approved preferred pharmacies; maintain key compliance criteria and implement quarterly reporting processes for all contracted network retail pharmacies
• Analyze network retail pharmacy quarterly reports to ensure compliance with reporting and participation requirements; collaborate with Clinical Program Directors to identify potential performance gaps; work with internal and external partners to develop and manage corrective action plans
• Responsible for effectively managing the pharmacy contract from negotiation of all terms, ensuring Prime and Pharmacy compliance and document retention aligning with Prime's Record Information Management (RIM) policies
• Work closely with Prime's legal team to update contract documents including agreements and applications for utilization in contracting/re-contracting activities based on new network participation requirements

Pharmacy Network Consultant – Principal

Account Executive

• Develops and executes sales and marketing strategies to attract new groups within the Blue Plan market to attain member growth.
• Leads the pharmacy sales process including the Request For Proposal (RFP) process, contract negotiations, site visits and follow up meetings.
• Works with the Assistant Vice Presidents, Employer Account Directors, and the sales team to drive joint Administrative Services Only (ASO) sales and member growth for Prime and the assigned Plan(s).
• Leads/co-leads prospecting activities with employer groups and consultants along with pipeline development/management and post bid discussions with groups/consultants while maintaining reporting in Salesforce.
• Establishes and maintains relationship with Salesforce and the account management teams at Plan(s) while maintaining accurate pipeline status and sales reporting/forecasting in CRM tool.
• Demonstrates a comprehensive knowledge of the company and our products and services, the market, the competition, and opportunities; relays Prime's key messages to appropriate members of the client sales, marketing, and account management team.
• Educates client sales, marketing, and account management teams on current topics in the industry, new product developments, and the competitive landscape; provides collateral materials and sales support to help facilitate the sales process.
• Coordinates with internal leaders and executives to develop message positioning, prospect development efforts and collateral needs from a sales perspective; relays Prime's key messages to appropriate members of the assigned Blues Account Team.
• Executes Go-to-Market meetings as needed (monthly, quarterly, bi-annual) with assigned Blue Plan(s) to review results, make and track product and service offering changes, provide market recommendations, and execute on plans in collaboration with Health Plan Markets leadership.
• Other duties as assigned

Sales Executive

Director

• Provide end to end oversight and management of multiple concurrent, highly complex product initiatives
• Collaborate with functional areas and strategic business unit leaders on new product ideation
• Lead concept ideation, design, early state feasibility assessment and financial analysis
• Conduct market assessments as needed
• Develop pricing strategy and drive through pricing committee
• Develop client or employer value story and product launch plan in concert with B2B marketing team
• Develop materials for and present individual product initiatives to senior management, including driving projects through stage gate approval
• Develop and present product training materials to client engagement and present initiatives / potential pilots to clients
• Partner with Marketing to create and maintain informative and compelling product collateral
• Other duties as assigned

Oncology Product Director

Manager

• Manage patient caseloads, conduct initial and follow-up assessments, and apply risk stratification to guide outreach and care team interventions
• Serve as the primary point of contact for patients enrolled in specialty care and support quality improvement initiatives such as reporting on adherence, compliance, patient safety and satisfaction
• Develop, implement, and monitor specialty patient care plans, setting measurable goals and promoting patient self-management
• Oversee Risk Evaluation and Mitigation Strategy (REMS) drug safety program requirements for designated medications, ensuring patient compliance and escalating non-adherence as needed
• Ensure continuity of care for newly enrolled patients by identifying needs, aligning care plans, and prioritizing treatment goals
• Assess patient needs and coordinate services while ensuring clear communication among patients, caregivers, providers, and community resources
• Document assessment outcomes, care planning, and clinical escalations accurately and timely, ensuring compliance with regulatory standards
• Must have flexible working hours
• Other duties as assigned

Senior RN Care Manager

• Develop clinical solutions and strategic roadmaps for specific therapeutic categories; oversee the development and implementation of product solutions
• Lead or provide support to Specialty program and product teams in development and maintenance of any additional specialty solutions
• Maintain knowledge of key industry trends
• Provide insight into competitor products and services
• Partner with various stakeholders to manage and monitor data in applicable areas
• Strategize with Networks to develop therapeutic category performance and reporting
• May lead or support in presenting program results and solutions to Clients

Director, Clinical Strategy and Integrated Specialty Solutions

Business Analyst

• Execute independently on small-sized projects or as part of a team of BAs on larger projects working closely with internal and external stakeholders to ensure superior customer and client experience
• Define and validate business needs with project team
• Participate in stakeholder analysis and identify subject matter experts needed for work effort
• Assess capability gaps, determine solution options and approach, and define solution scope
• Plan business analysis approach and activities
• Prepare for, conduct, and document elicitation sessions
• Manage requirements traceability to solution scope, objectives, system requirements, and testing
• Define user acceptance testing approach
• Adherence to business analysis discipline and standards in accordance with the Prime Project Lifecycle methodology

PBM Business Analyst

Product Manager

• Deliver solution products that drive value for customers
• Manage product discovery and backlog prioritization
• Collaborate with engineering teams to understand business problems
• Participate in sprint planning, reviews, and retrospectives
• Develop relationships with internal groups and customers

Senior Solution Product Owner

Administrative Assistant

• Provide administrative support to at least two members of Prime’s Senior Leadership Team (SLT) members and their corresponding departments; serve as a representative of the assigned function by effectively managing telephone calls and/or visitors and ensuring a consistent experience for all guests of the department or facility
• Manage calendar(s) as assigned and ensure adherence to scheduled appointments; specifically responsible for the intake, prioritization and scheduling of new meeting requests, as well as supporting on-time transition between meetings or appointments
• Coordinate travel on behalf of leaders or team members and ensure the appropriate lodging, car service and/or other necessary accommodations are secured; may be responsible for contracting with vendors to secure facilities and/or negotiate rates in the best interest of Prime
• Coordinate large team meetings and/or conferences that may extend beyond immediate department support; ensure facilities, technology and materials or handouts are adequately prepared and distributed
• Document, maintain and enforce policies and procedures in support of department leadership or business operations; serve as initial point of contact within the department for guidance, approval or routing to the appropriate parties on policies/ procedures that are administrative in nature
• Support department with general office duties and special projects, including but not limited to preparing presentations, meeting materials, onboarding/offboarding activities, coordinating print, administering the recognition program, ordering supplies, maintaining records and/or coordinating site events
• Capture and distribute meeting minutes at leadership or other management or committee meetings
• Works independently and within a team on special, nonrecurring or ongoing projects at the discretion of assigned SLT member; plan and coordinate presentations, disseminate information, follow up with cross-functional participants, design and deliver general correspondences, memos, charts, tables, graphs etc and proofread/edit copy for spelling, grammar and formatting inconsistencies; may be accountable for accuracy and clarity of final copy
• Other duties as assigned

Senior Administrative Assistant – IT

Analyst

• Research and resolve pharmacy contract related inquires; evaluate network participation and distribute pharmacy contract documents; coordinate timely, accurate and complete submission of contract deliverables, and the electronic and physical tracking, storage and distribution of contract documents
• Ensure all contractual obligations adhere with company policies, regulatory compliance and legal requirements; engage with Legal and Network Management leadership as needed to ensure the language provided is accurate and concise
• Establish, develop, and maintain relationships with independent pharmacy providers
• Manage legal-to-legal correspondences between Prime and independent Pharmacy Providers escalating to Prime Legal Counsel as required
• Conduct root cause analysis, including but not limited to, investigating, monitoring, resolving and reporting for pharmacy contract and pricing analysis complaints issues
• Evaluate pharmacy inquiries to include but not limited to complaints, issues and/or grievances and collaborate with internal stakeholders, such as Network Management, Client Engagement, and Benefit Operation
• Manage and edit Prime’s Provider Manual to ensure compliance and timely distribution, while contributing to process improvements that support cross-functional projects, regulatory changes, and client implementations
• Other duties as assigned

Senior Provider Relations Analyst

• Act as a champion of consulting and analytic methodology for designated line of business
• Develop analytic methodologies, models, reports and new products
• Lead complex client analytical work efforts
• Proactively investigate and build recommendations for enhancements or resolution regarding key drivers of benefit performance

Senior Drug Rebate Analyst

Consultant

• Serve as subject matter expert for assigned business systems or processes, developing requirements, specifications, process flows, and supporting change management or project delivery
• Partner with internal and external stakeholders to maintain and enhance existing applications, resolving business and technical issues to improve efficiency and user experience
• Research, evaluate, and recommend improvements to processes and system functionality, applying operational best practices and aligning with business needs
• Conduct system testing, including creation of test plans and cases, execution of User Acceptance Testing (UAT), and documentation of results to ensure quality and compliance
• Collaborate across teams to monitor and ensure compliance with applicable regulations, laws, and audit requirements, while mitigating risk through proactive process improvements

Functional Business Consultant

Risk

• Develop, implement, and maintain the ERM framework and methodology to identify, measure, monitor, and control enterprise-wide risks
• Partner with leaders across the business (Operational Risk, Compliance Risk, Information Security, etc.) to enhance the ERM function, ensuring effectiveness and efficiency
• Collaborate with stakeholders to fully develop and articulate the company’s risk management framework, clarifying roles and responsibilities of the three lines of defense
• Provide expertise in the identification and assessment of controls, development or enhancement of these controls, process improvement activities, and assessment of self-monitoring programs by management
• Define and maintain policies and SOPs for ERM framework components (risk register, issue management, incident management, etc.)
• Provide oversight and advice on compliance with the ERM Framework
• Manage the development, coordination, and administration of the ERM function, including setting, reviewing, and measuring risk management standards, and documenting standards, processes, and procedures
• Build, maintain, and enhance business relations with department and business heads for the smooth implementation of risk management activities across the organization
• Provide leadership to staff ensuring the prioritization of strategic and department level initiatives to include defining performance goals and targets. Coaching and leading a high-performance team

Manager, Enterprise Risk Management

Therapist

• Receive inbound and make outbound calls to eligible beneficiaries to schedule MTM clinician interventions in a manner that meets the specialized needs of the targeted population
• Utilize Prime’s MTM process management system to record member specific information
• Assess beneficiary information to ensure appropriate interaction is scheduled with appropriate MTM clinician (i.e., Pharmacist)
• Perform outreach calls to pharmacies to research contact information
• Address and triage queries regarding MTM related topics by transferring calls to MTM staff or other department help lines
• Document MTM eligibility and program status in the applicable software systems (i.e., MSA Toolbox, RX Claim)

Medication Therapy Management Technician

Architect

• Lead and provide thought leadership in all areas of data and information management, including master and reference data management, data modeling, data governance, data quality, data standardization, and metadata management.
• Lead and/or facilitate enterprise information and data strategy development to achieve enterprise goals and objectives
• Actively manage, communicate, and market the enterprise information architecture strategy and techniques via creation and maintenance of architecture blueprints, roadmaps, and executive presentations
• Promote and support elimination of data redundancy, fragmentation, and unnecessary movement of data through the establishment and enforcement of data system of record (SOR), source of truth (SOT), source of origin (SOO).
• Continuously improve and mature information and data architecture practice and processes
• Lead the development and application of information policies, principles, standards, patterns, and governance processes for information, data, and metadata to achieve an integrated definition of data for enterprise information, and to ensure the accuracy, validity, and reusability of metadata.
• Maintain awareness, research, drive, and lead adoption of emerging IT trends, disruptions, and practices relevant to enterprise information and data architecture
• Engage leadership to identify business and technology-enabled innovation opportunities that enable and drive business outcomes
• Lead the analysis of the business-IT environment to detect critical deficiencies, legacy, and technical debt, and recommend solutions for improvement
• Develop, maintain, and evolve the architecture and solution intent (current state, transition state, and future state) across domains
• Assist in maintaining the repository of current state, transition state, and future state information architecture deliverables
• Lead and facilitate Data Architecture community of practice meetings and represent the information and data architecture domain at the Architecture Review Board.
• Work closely with the product portfolio owners and product managers to drive a robust information and data architectural runway that can support future business requirements throughout the product and solution lifecycle
• Coach, mentor, and collaborate with technical subject matter experts and architecture peers to develop architecture that enables and drive new business capabilities and operating models

Senior Principal Enterprise Information Architect – Client and Member

Pricing Analyst

• Recommend new and revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other relevant data of varying complexity within the pharmacy economic supply chain; utilize analytics to explore data, identify trends, and draw profitability, margin, and costs insights from multi-faceted and high dimensional financial pricing data
• Develop financial pricing models to monitor performance against pharmacy claims data and identify financial pricing opportunities to drive savings and/or meet client/pharmacy contractual obligations using analytic tools and complex financial pricing methodologies
• Apply mathematical, statistical, and economic techniques to identify key drivers of costs and profitability in the pharmacy economic supply chain as they apply to financial pricing programs, and propose and implement changes to improve accuracy of financial pricing modeling
• Act as a financial pricing subject matter expert by educating internal/external financial pricing stakeholders on financial pricing programs and interpretation of financial pricing data and reporting
• Create, recommend, implement pharmacy financial pricing targets for use by Providers Relations teams and/or pharmacy/client guarantee management processes
• Other duties as assigned