Prime Therapeutics

Program Manager

• Provide project coordination and administrative support to Clinical Program Management, Utilization Management, Formulary, GuidedHealth, Pharmaceutical Trade Relations, Pharmacy Audit, Clinical Operations and/or Specialty Pharmacy
• Develop, generate, analyze, quality check, and coordinate delivery of client and internal program reporting (UM Savings, Compliance, Utilization data, DURs, member eligibility, pharmacy/pharmaceutical performance and analytics)
• Support RFP and implementation processes by gathering information, requirements, and communicating status to business partners
• Create and maintain client, member, and physician communications and templates, member disruption mailings, and utilization requests; may participate in fulfillment
• Develop and maintain business process flows and desktop procedures for designated functional area
• May support clinical rules maintenance (GPI lists, other lists) and/or client invoicing for programs
• Perform other duties as assigned

Program Analyst

Account Executive

• This is an Individual Contributor/Client Facing Role.
• The Clinical Account Director is responsible for the management of all client's clinical programs and drug strategy recommendations including drug formulary, Utilization Management programs, and other drug therapy related products and services offered by Prime.
• As the primary point of contact for their designated BCBS clients, the director promotes and recommends Prime standard offerings to meet client requirements and builds strong relationships with key clinical stakeholders through effective consultative services.
• Coordinate formulary management for the client including, client specific Pharmacy &Therapeutics (P&T) or business committee decision making and implementation, oversight of formulary publications, oversight of formulary information in all provider and member materials and communications, and product ownership for Medicare and Medicaid formularies
• Provide consultation and recommendations to the client regarding Prime standard clinical program opportunities, formulary recommendations, benefit design recommendations, and other research applications and opportunities beneficial or of interest to the plan
• Provide clinical guidance and support for client's Health Insurance Marketplace business
• Manage incoming requests for information from the plan regarding drug therapy, formulary and clinical program related issues and partner with reporting and analytics team to present meaningful information back to the client
• Present Prime's products, services and recommendations to internal and external stakeholders and work in cooperation with Prime's operational teams to coordinate and lead client specific custom clinical pharmacy programs
• Other duties as assigned

Clinical Account Director

Financial Planning and Analysis

• Lead cloud cost tracking, demand forecasting inputs, and optimization programs across multiple platforms (AWS, GCP, Azure, OCI).
• Analyze cost and usage data, identify savings opportunities, and partner with engineering teams for implementation.
• Establish and maintain governance processes for cost reviews, workload deployments, and migration planning.
• Collaborate with Finance on budgeting, chargeback/showback, and spend accountability processes; provide accurate demand forecasts and usage trends as inputs.
• Develop and maintain cloud cost dashboards, custom reports, and KPI tracking for IT, Finance, and business leadership.
• Administer and enhance cloud financial management tools; coordinate tool onboarding, tagging compliance, and automation initiatives.
• Engage with cloud provider account teams to incorporate best practices and address service/cost updates.
• Translate technical cost data into clear business impacts for diverse audiences, including executives.
• Train and educate engineers and stakeholders on cost management processes and FinOps principles.
• Partner with Procurement and Vendor Management to optimize contracts and leverage private pricing programs.
• Other duties as assigned.

Senior Cloud Financial Operations Analyst

Vice President

• The Vice President Pharmaceutical Trade Relations oversees the development of Prime's pharmaceutical relations strategy and manages Prime's corporate relationship with pharmaceutical drug manufacturers. This position leverages a deep understanding of the healthcare marketplace and pharmaceutical industry to prepare the organization for future success by developing and implementing innovative strategies and solutions which address changing market demands and ensure Prime is delivering the highest quality and lowest cost of care to its members and related client messaging as well as strategy pull through.
• Maintain expert knowledge of the pharmaceutical industry, drug trends and drug pipeline to capitalize on savings through effective negotiation and contracting
• Develop strong working relationships and communication at all levels of the organization and foster an environment of collaboration and communication; partner with leaders across clinical, sales and client engagement to bring competitive opportunities to market and facilitate implementation
• Provide strategic direction and oversight of programs and solutions that support Prime's objectives; collaborate with internal and external stakeholders on the execution of the strategy that increase value within the marketplace; lead negotiations and discussions (e.g., medical products, rebate agreements, pharmaceutical manufacturer contracts) to ensure alignment and compliance with distribution fees, pricing, messaging and other critical factors
• Manage external and internal relationships necessary to position products and solutions within the market or with pharmaceutical manufacturers; represent company objectives and perspective to external partners (i.e., pharmaceutical manufacturers, clients, marketplace, medical professionals, etc.) and communicate to ensure understanding of mutual objectives; based on solutions ensure manufacturers' products are brought forth internally to evaluate rebate and formulary opportunities for Prime's business
• Provide key leadership within Trade Relations department to ensure effective problem resolution and team and personal development of direct reports; serve as escalation contact for complex client, manufacturer, and other external partner contract analyses and language needs
• Provide oversight for development activities for assigned areas, such as medical policy or formulary, in collaboration with cross-functional areas and committees; lead work related to the identification of key product categories, the development of manufacturer contracts and the presentation of corporate recommendations to committee(s); partner with cross-functionally with Clinical Program Management, Specialty, Health Plan Markets and other internal business functions to ensure appropriate downstream implementation as appropriate
• Oversee the creation and delivery of detailed analysis and innovative solutions which reduce client drug spend, ensuring a consistent linkage with Prime's strategies and initiatives and facilitating shared goal setting. Establish and maintain a productive and influential relationship with key client stakeholders to ensure effective collaboration, communication and delivery of services
• Other duties as assigned.

VP Pharmaceutical Trade Relations

Business Analyst

• Lead design, implementation, and execution of ERM framework and methodology aligned with industry standards to identify, assess, monitor, and manage enterprise-wise risks
• Lead key risk management initiatives, collaborate with cross-functional teams, and embed risk considerations into strategic and operational decision-making
• Provide analytical support and insight in identifying and assessing controls, contribute to the development and enhancement, assist in process improvement initiatives, providing data-driven recommendations, and support the evaluation of management's self-monitoring programs
• Contribute to the development and maintenance of related policies and standard operating procedures for key components such as the risk register, issue management, and incident manager
• Provide recommendations to Prime’s Executive Leadership Team, Senior Leadership Team, and Strategy and Risk Committee of the Board
• Other duties as assigned

Senior Enterprise Risk Management Analyst

Engineer

• Manage the Data Protection program to ensure all systems are being backed up, reported and validated properly; facilitate annual testing of data protection processes in accordance with Prime's IT Disaster Recovery Program
• Lead efforts to collaborate with IT senior leaders and senior level business stakeholders to understand business and technical requirements and continuously adapt the IT Data Protection Program to meet changing risks, requirements, and opportunities
• Manage the Disaster Recovery as a Service (DRaaS) recovery solution including gathering requirements, performing testing, determining application readiness, and working with DRaaS provider and IT Disaster Recovery Program to ensure delivery of service
• Design and manage the IT Data Protection Program to ensure compliance with RIM policies; execute on annual testing, test scheduling with internal and external DRaaS systems, present status reporting and partner with IT Recovery Team to executing less-complex tests for their Data Recovery plans
• Serve as subject matter expert for IT Data Protection technology solutions and processes across the enterprise; lead cross function teams during disaster or crisis situations to drive swift and optimal recovery of IT systems
• Lead and/or participate in IT and business tabletop exercises regarding DR/BCP
• Continuously identify opportunities to improve and optimize processes, procedures, and program scope to ensure best value to Prime
• Other duties as assigned

Senior Data Protection Engineer

QA Engineer

• Design test plans, automate test scenarios, and perform testing based upon functional requirements, user stories, and non-functional requirements
• Test case documentation, support for testing activities (functional, regression, smoke, platform, performance) and test automation
• Assist in debugging, analyzing test outcomes, certifying integrations, and recommending corrective action for failures
• Identify, build, implement automation frameworks for testing activities
• Maintain, and support necessary tools required for the frameworks
• Participate in small teams to define and implement test solutions
• Aid in definition of Quality strategy for teams
• Participate in QEC activities such as metrics, training, grooming of roadmap, and reporting
• Other duties as assigned

IT Quality Engineer, Automation

• The Enterprise Risk Management Analyst is responsible for assisting in analyzing risks within the company, identifying potential threats to the business, and developing strategies to mitigate and manage risks.
• The role supports implements risk management policies and procedures, conducts risk assessments, analyzes data to identify trends and potential risks, and provides recommendations to leadership to improve overall risk management practices.
• This position will collaborates with various departments to ensure compliance with regulations and industry standards.
• Responsibilities: Support the identification of potential risks across operational, financial, regulatory and strategic domains
• Assist in conducting risk assessments using qualitative and quantitative methods to prioritize risks based on likelihood and impact
• Identifies and analyzes data on emerging risks, including preparing and presenting risk insights to leadership and stakeholders
• Collaborates with leadership to develop and implement risk mitigation plans and controls
• Monitors key risk indicators (KRI's) and report on exposures to ensure timely escalation and resolution
• Support the maintenance of the enterprise risk register, ensuring accurate documentation and updates, while collaboration with cross-functional teams to promote and embed risk management practices across the organization
• Other duties as assigned

Enterprise Risk Management Analyst

• The Employer Account Executive serves as the primary relationship manager for multiple employer/administrative services only (ASO) accounts.
• This position works directly with employer groups to optimize pharmacy spend through Prime's products and services, and drives the alignment of Health Plan, Employer and Prime's strategic goals and initiatives.
• The client for this position is located in New Jersey, p reference to someone that lives within the state or the surrounding area.
• Develop and maintain key relationships with Plan's account and pharmacy teams, and with corresponding consultants/brokers; maintain an intimate understanding of the industry and assigned account trends, challenges, priorities, and adopted products and services to influence the development and prioritization of strategic plans
• Maintain and drive strategic master account plans to ensure client engagement and satisfaction; drive cross-functional alignment between Prime and the strategic plan of the client, ensuring contract compliance and measurement of key deliverables
• Establish key internal relationships in order to advocate for client interests and help drive enterprise solutions that meet Prime and client priorities; work with Employer Account Manager to ensure member and client service excellence and satisfaction
• Lead client meetings as aligned to the account management principles, including but not limited to: identifying meeting objectives and participants, ensuring adequate preparation and presentation materials, disseminating and uploading meeting materials in client portal, and working across extended teams to ensure appropriate follow through and documentation; drive superior client satisfaction and engagement in all client interactions, including the co-development and implementation of the pharmacy master account plan per client
• Working with the Plan's account teams, lead the proactive and strategic consultation efforts to maximize pharmacy spend through client renewals and the adoption of new or expanded use of Prime's products and services
• Educate Employer groups on current topics in the industry, new product developments, and the competitive landscape; provide collateral materials and support when necessary to help facilitate the sales process; assist with client external audits, client presentations, client visits, and health fairs, as needed
• Manage the end-to-end RFP process for renewing groups, including the development of a contract renewal project plan; proactively analyze contract language and/or requirements, standardize where appropriate, and mitigate conflicting terms
• Document interactions with assigned accounts and input into the Salesforce CRM tool, including but not limited to meeting agendas and notes, identified dependencies or risks, key decision points and outcomes, and any next steps, agreed actions and responsibly parties; ensure the appropriate data is captured within Salesforce in order for the tool to be leveraged as a source of truth for the overall client relationship (client interactions, products pitched and deployed, decision records, etc)

Employer Account Executive

Architect

• Prime Therapeutics is modernizing its data, reporting and analytics portfolio leveraging Cloud services.\n• The Enterprise Portfolio Architect leads the analysis and design tasks to support the development of enterprise solutions that cross multiple domains and align with architecture governance and standards.\n• Creates target-state guidance (reusable standards, guidelines, individual parts, platforms, and configurations) for evolving the architecture across the enterprise.\n• Leads the architecture and solution definition for strategic initiatives, products, and projects impacting Prime\'s reporting and analytic solutions, environments, and platforms.\n• Partners with product portfolio owners and product managers to drive a robust architectural runway that can support future business requirements throughout the product and solution lifecycle.\n• Maintains awareness of emerging IT trends, disruptions, and practices relevant to reporting, analytics, and Business Intelligence.\n• Engages leadership to identify business and technology-enabled innovation opportunities that enable and drive business outcomes.\n• Collaborates with Enterprise Information Architect, Data Governance, Privacy, and IT security to ensure appropriate treatment of data privacy, protection, access, usage and quality policies and controls.\n• Coach, mentor, and collaborate with technical subject matter experts and architecture peers to develop and mature enterprise and portfolio architecture practices.\n• Other duties as assigned.

Sr. IT Principal Architect, Remote

Underwriter

• Oversees and coordinates workflow for the existing client underwriting group
• Manages a team of underwriters in support of the underwriting process; responsible for guidance and development of direct reports
• Coordinates modeling and tracking of revenue streams generated by existing clients
• Provides support to Sales and Client Engagement, assisting in the development of client presentations and negotiations pertaining to pricing and guarantees
• Engages with Sales and Client Engagement to provide input into the development of client specific pricing strategies
• Monitors trends and identifies the need for new or revised procedures and practices to achieve profit, sales and retention objectives
• Participates in development of methodologies, models, and reports to support objectives of the position
• Develops key internal relationships with business partners to ensure efficient and effective business processes and transactions
• Other duties as assigned

Manager Underwriting - REMOTE

Operations

• Lead cost optimization and financial governance across GCP and AWS.
• Partner with IT and Finance to drive efficient cloud spend, forecasting, and accountability.
• Continuously innovating and improving our path on cloud financial controls and optimization, while helping to drive a culture of accountability regarding efficient cloud usage/spend.
• This position will be part of the IT cloud platform team and will work together with Prime's finance teams to ensure financial rigor on cloud spend through cloud controls and processes.
• Analyze cloud usage and identify cost-saving opportunities across GCP and AWS.
• Implement financial governance frameworks and cloud optimization strategies.
• Build dashboards and reports using tools like BigQuery, Athena, Looker, or Power BI to monitor cloud spend.
• Present financial insights to IT, Finance, and business leadership.
• Collaborate with engineering and DevOps teams to align cloud architecture with financial goals.

Sr Cloud FinOps Analyst - Remote

Manager

• The Manager Workforce manages the Workforce Team and partners with Operations leaders and financial planning to work toward realizing performance goals.
• This position identifies and analyzes opportunities for efficiencies utilizing standard process control tools and drives service and expense improvements by providing operations analysis, reporting and process improvement for Operations.
• The position may analyze, test, and document business requirements and system capabilities.
• Define key performance metrics to provide managers a solid understanding of operations performance; devise data collection methods for the metrics and design reports and identify, develop and implement potential solutions to resolve problems and remove barriers that inhibit the department's ability to improve operations
• Manage departmental staff, ensuring quality results and policy compliance
• Oversee the development of schedules and scheduling approaches to improve service levels, reduce cost and achieve performance goals
• Oversee delivery of contact center and operations performance reports as well as ad hoc reporting, including preparation of employee incentives
• Oversee long and short-range workforce forecasting for call center operations and participate in budget and hiring planning
• Other duties as assigned

Manager Workforce - Remote

Accounts Receivable

• The Supervisor of Corporate Accounting is responsible for overseeing various aspects of the month-end/year-end close accounting processes, maintenance of the general ledger, execution of internal controls, and day-to-day supervision of multiple Accountants.\n• This position interacts with key stakeholders across the organization while providing accounting support and analysis to management; and will be visible to members of the senior leadership team in certain contexts.\n• Lead, coach and develop team members to deliver on department goals, coordinate workload, ensure quality, establish procedures, and meet stakeholder expectations\n• Lead the work of direct reports, contributing to a timely and efficient month-end close process while ensuring compliance with U.S. GAAP and company policies\n• Drive the month-end balance sheet reconciliation process, ensuring accuracy, timeliness and completion of all account receivables\n• Collaborate with internal business partners to deliver quality support, resolve discrepancies, and appropriately account for judgmental accrual areas including client and network financial guarantees\n• Supervise all activities related to the maintenance and reporting of general corporate financial records and systems to accurately reflect the company’s financial activity and condition\n• Participate in the development of new accounting processes in response to strategic changes in Prime’s business, ensuring maintenance of a strong system of internal controls over corporate accounting processes\n• Provide comprehensive, accurate, timely and relevant financial analysis and reporting to Prime management\n• Other duties as assigned

Accounts Receivable Supervisor - Remote

Analyst

• The Senior Pricing Analyst participates in the assessment of value generated by Prime''s programs and leverages this insight to contribute to the development of new or enhanced financial pricing strategies.
• This position will also lead highly complex financial pricing analyses and provide consultation and analytic insight to internal and external stakeholders.
• Responsibilities include recommending 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

Senior Analyst Pricing - Remote

Pricing Analyst

• Lead highly complex financial pricing analyses using pharmacy data; provide insights to internal/external stakeholders
• Develop financial pricing models to monitor performance and identify opportunities
• Apply mathematical, statistical, and economic techniques to pricing; drive improvements
• Educate stakeholders on pricing programs, interpretation, and reporting; create targets for provider relations and client guarantees
• Collaborate with cross-functional teams to implement pricing changes

Pricing Analyst Senior - Remote

• Analyze clients' quality data to develop and recommend strategies for improvement and/or maintenance of quality ratings; create and manage project plans to meet established client quality goals
• Drive the client quality strategy for all lines of business (Medicare, Medicaid, Commercial/HIM); serve as primary point of contact and subject matter expert on all quality matters pertaining to assigned clients and area of focus
• Collaborate with key internal and external stakeholders, including Prime's clients, client engagement and clinical functions and external vendors, to ensure needs are understood, capabilities are aligned, and initiatives are on schedule and within budget
• Lead monthly client meetings to review quality reporting and status of strategic plan implementation, and discuss other capabilities, tools or products that could address issues
• Lead monthly internal work groups based on area of focus including reporting, issue management and strategic direction related to quality
• Understand quality compliance and the internal and external factors which impact client quality strategy
• Work cross-functionally to identify and guide improvement in tools, capabilities, products or data that would help clients to improve quality ratings
• Build external client satisfaction by establishing client-facing relationships with health plan quality leaders and successfully implementing quality initiatives
• Other duties as assigned

Client Quality Manager - Remote

Technical Writer

• Senior Technical Writer is responsible for creating, editing, reviewing and publishing complex documentation
• Coordinates, prioritizes and implements writing and documentation projects including rotating review and maintenance of existing documentation
• Routinely collaborates with subject matter experts (SMEs), Trainers and Business Process Analysts and management in development and production of materials for new processes and plans
• Mentors and coaches Technical Writers; leads the work of other Technical Writers on large projects
• Uses tools such as Microsoft Office Suite, RxCLAIM, Benefit Edit Tool, IBM Notes, CoverMyMeds, Clinical Review Engine, MSA, Clinical Operations Review Engine, and Prime Knowledge Resources
• Ensures templates, design style and layout conform to department standards
• Creates new documentation prior to new client or process implementation or in absence of necessary materials and distributes appropriately
• Other duties as assigned

Senior Technical Writer - Remote

• The Diversity, Equity & Inclusion Program Manager Sr is responsible for executing plans that drive diversity, equity, and inclusion (DEI) awareness and education, and supports work that aligns with Prime's DEI values and strategy.
• This role will provide oversight and strategic direction to the DEI Council and Employee Resource Groups (ERGs), playing a key role in the development and execution of robust DEI programs and process improvements.
• This role will support the creation and maintenance of programs and strategies to help attract, develop, engage, and retain diverse talent.
• Lead cross functional projects to deliver on DEI strategies and initiatives; create and manage project plans to deliver upon goals and ensure satisfactory results and delivery within established deadlines and budgets
• Advance the DEI mission and initiatives through planning and execution of events and roadshows; serve as a partner, connector, and advisor to DEI champions across the organization
• Identify and establish external partnerships that support company DEI programs and initiatives; develop community outreach efforts and represent Prime at DEI events
• Advise on policies and programs, and represent DEI on cross functional projects as needed; identify gaps and recommend actions that drive DEI progress for underrepresented groups
• Serve as an advisor/subject matter expert to internal partners (e.g., Prime Together Foundation, Talent Acquisition, Learning & Development)
• Manage annual inclusion surveys and drive action on opportunity areas
• Support DEI data and reporting needs; monitor and analyze DEI metrics and identify insights and recommend actions within HR; partner and consult with HR Compliance, HR Reporting and Talent Analytics on DEI-related data as needed

Diversity, Equity, and Inclusion Program Manager, Senior - Remote

• The Pricing Analyst maintains, provides analyses, consults and conducts financial modeling in support of Prime's financial pricing programs and/or underwriting functions.
• This position uses analytics to develop reporting, models and methodologies in support of Prime's financial pricing strategies and assists with high-complexity pricing analyses.
• Analyze and produce pharmacy claims data reporting of varying complexity to assess competitiveness & accuracy of Prime's financial pricing programs against adjudicated claims to identify trends and draw insights to provide pricing recommendations
• Apply mathematical, statistical, and economic techniques to analyze multi-faceted and high dimensional pharmacy supply chain economic data, including market pricing, to draw conclusions, adjust drug pricing, and update forecasts based on market
• Verify the integrity of data used for analysis of Prime's financial pricing programs, including data extraction, storage, manipulation, processing and analysis
• Analyze claims data of varying complexity to identify and mitigate financial pricing issues that impact client and pharmacy financial pricing guarantee management
• Assist in achieving pricing objectives using analytic tools to develop financial pricing models, dashboards, trend reporting, profitability, margin, and savings analyses
• Collaborate with internal stakeholders to identify and define financial pricing requirements and assist with developing solutions to achieve financial pricing objectives
• Other duties as assigned

Consultant

• The Network Management Consultant is responsible for development, performance and management of Prime's retail, mail, specialty, and quality-based networks aligning with Prime's Supply Chain Cost of Goods Sold (COGS) and network management strategies.
• This includes development of network contracts, participation requirements, analysis of pharmacies, and ensuring contract and regulatory compliance.
• This position is accountable for creation and management of specialty fee schedules to ensure competitiveness and serves as the liaison between Prime's Network Management and Specialty teams.
• Responsibilities
• Negotiate market competitive high-profile and/or complex pharmacy agreements across all channels including retail, mail, specialty and quality based and lines of business aligning with Supply Chain COGS strategies
• Lead and manage specialty fee schedule development process and ensure fee schedule revisions align with Supply Chains COGS strategies for specialty drug management
• 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 and specialty pharmacies; maintain key compliance criteria and implement quarterly reporting processes for all contracted network specialty pharmacies
• Analyze network specialty pharmacy quarterly reports to ensure compliance with reporting and participation requirements; collaborate with Specialty 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
• Other duties as assigned