Prime Therapeutics

Principal Actuary - REMOTE

Prime Therapeutics · Full Time · 3 hours ago

Prime Therapeutics

🌎 United States 💵 $124K - $211K per year ⭐ 10+ yrs exp 💼 Finance

The Principal Actuary provides strategic consulting and thought leadership for pricing initiatives and actuarial modeling across all lines of business. They lead complex, high-visibility projects and mentor team members while ensuring compliance with federal regulations and actuarial standards.

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Senior Analyst – Pharmacy Pricing - REMOTE

Prime Therapeutics · Full Time · 2 days ago

Prime Therapeutics

🌎 United States 💵 $81000 - $138K per year ⭐ 5-10 yrs exp 💼 Healthcare

The role involves developing pharmacy pricing and rebate analyses for existing and prospective clients. It requires partnering with actuaries and senior leaders to translate complex pharmacy datasets into clear, decision-ready insights.

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Lead Actuary – Pharmacy Pricing - REMOTE

Prime Therapeutics · Full Time · 2 days ago

Prime Therapeutics

🌎 United States 💵 $124K - $211K per year ⭐ 10+ yrs exp 💼 Finance

Lead complex pharmacy pricing and rebate guarantee analyses for existing and prospective clients. Partner with senior leadership to provide strategic pricing guidance and mentor junior actuarial team members.

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Sr. IT Security Trainer - Remote

Prime Therapeutics · Full Time · 2 days ago

Prime Therapeutics

🌎 United States 💵 $81000 - $138K per year ⭐ 5-10 yrs exp 💼 Teaching

Develop and deliver a comprehensive information security awareness program to reduce human-related security risks across the organization. This includes executing tabletop exercises, administering phishing programs, and translating technical concepts for non-technical audiences.

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Physician Clinical Reviewer - Pediatric Gastroenterology- REMOTE

Prime Therapeutics · Full Time · a month ago

Prime Therapeutics

🌎 United States 💵 $90.87 - $154.33 per hour ⭐ 5-10 yrs exp 💼 Healthcare

Perform medical reviews of service requests that do not meet initial medical necessity guidelines and provide clinical rationale for appeals. Collaborate with requesting physicians and the Medical Director to ensure consistency and compliance with URAC and NCQA guidelines.

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Business Integration Consultant Principal - Remote

Prime Therapeutics · Full Time · a month ago

Prime Therapeutics

🌎 United States 💵 $108K - $184K per year ⭐ 5-10 yrs exp 💼 Software Development

Lead client implementation activities and execute functional strategies to drive key business outcomes. Manage a team of Business Integration Consultants while overseeing enterprise-wide projects and client engagements.

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Physician Clinical Reviewer - Rheumatology- REMOTE

Prime Therapeutics · Full Time · a month ago

Prime Therapeutics

🌎 United States 💵 $90.87 - $154.33 per hour ⭐ 5-10 yrs exp 💼 Healthcare

The Physician Clinical Reviewer conducts timely medical reviews of service requests that do not meet initial necessity guidelines. They also provide clinical rationale for appeals and act as a resource for the utilization management team.

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Health Plan Sales, VP - REMOTE

Prime Therapeutics · Full Time · a month ago

Prime Therapeutics

🌎 United States 💵 $143K - $243K per year ⭐ 10+ yrs exp 💼 Sales

The VP of Health Plan Sales is responsible for driving new business sales and developing strategic relationships within the health plan market segment. They will lead the end-to-end bid process, including RFP management, proposal development, and finalist presentations to secure new partnerships.

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Program Manager Sr - Remote

Prime Therapeutics · Full Time · a month ago

Prime Therapeutics

🌎 United States 💵 $94000 - $160K per year ⭐ 5-10 yrs exp 💼 Product

The Senior Program Manager leads and executes core programs, specifically focusing on interoperability and API management. They drive enterprise-wide alignment with CMS mandates and collaborate with cross-functional teams to ensure successful program implementation.

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Senior HRIS Analyst

Prime Therapeutics · Full Time · 2 months ago

Prime Therapeutics

🌎 United States 💵 $81000 - $138K per year ⭐ 5-10 yrs exp 💼 Recruitment

The Senior HRIS Analyst provides technical support, configuration, and testing for HR information systems including payroll, benefits, and compensation. They also participate in cross-functional HR projects and act as the application owner for assigned HR products.

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Senior Principal Actuary - REMOTE

Prime Therapeutics · Full Time · 2 months ago

Prime Therapeutics

🌎 United States 💵 $143K - $243K per year ⭐ 10+ yrs exp 💼 Finance

The Senior Principal Actuary provides actuarial direction, thought leadership, and innovative pricing strategies for pharmacy benefit management. They are responsible for leading complex data analyses, mentoring staff, and presenting strategic insights to executives and clients.

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Sales Executive - Remote in WA or OR

Prime Therapeutics · Full Time · 2 months ago

Prime Therapeutics

🌎 United States 💵 $108K - $184K per year ⭐ 5-10 yrs exp 💼 Sales

The Sales Executive develops and executes sales strategies to attract new groups within the Blue Plan market to drive member growth. They lead the pharmacy sales process, including RFP management, contract negotiations, and maintaining relationships with key stakeholders.

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Pharmacy Network Consultant Senior - Remote

Prime Therapeutics · Full Time · 2 months ago

Prime Therapeutics

🌎 United States 💵 $74000 - $118K per year ⭐ 5-10 yrs exp 💼 Healthcare

The Pharmacy Network Consultant is responsible for negotiating and managing pharmacy agreements across retail, mail, and quality-based channels. They also represent the network management department in audits, cross-functional projects, and client service initiatives.

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Pharmacy Network Consultant Principal - Remote

Prime Therapeutics · Full Time · 2 months ago

Prime Therapeutics

🌎 United States 💵 $94000 - $160K per year ⭐ 10+ yrs exp 💼 Healthcare

The consultant is responsible for the development, performance, and management of retail, mail, and quality-based pharmacy networks to align with supply chain cost strategies. They will lead contract negotiations, perform network analyses, and ensure compliance with regulatory and internal requirements.

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Provider Relations Analyst Sr - Remote

Prime Therapeutics · Full Time · 2 months ago

Prime Therapeutics

🌎 United States 💵 $66000 - $106K per year ⭐ 5-10 yrs exp 💼 Others

The Senior Provider Relations Analyst manages independent pharmacy network contracting activities and ensures compliance with company policies and regulatory requirements. They also resolve escalated pharmacy inquiries, maintain the Provider Manual, and conduct root cause analysis for contract and pricing complaints.

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Pharmacy Network Consultant Senior - Remote

Prime Therapeutics · Full Time · 2 months ago

Prime Therapeutics

🌎 United States 💵 $74000 - $118K per year ⭐ 5-10 yrs exp 💼 Healthcare

The Pharmacy Network Consultant Sr is responsible for the development and management of Prime's pharmacy networks, including negotiating pharmacy agreements and managing contracting initiatives. This role also involves representing Network Management in audits and cross-functional projects.

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Physician Clinical Reviewer-Pediatric Oncologist- REMOTE

Prime Therapeutics · Full Time · 3 months ago

Prime Therapeutics

🌎 United States 💵 $90.87 - $154.33 per hour ⭐ 5-10 yrs exp 💼 Healthcare

This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, requiring interaction with physicians and providers to discuss determinations and provide clinical rationale for appeals. The reviewer also assists in maintaining consistency by utilizing clinical review guidelines and participating in training and research activities related to utilization management.

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Physician Clinical Reviewer - Urology- REMOTE

Prime Therapeutics · Full Time · 3 months ago

Prime Therapeutics

🌎 United States 💵 $90.87 - $154.33 per hour ⭐ 5-10 yrs exp 💼 Healthcare

This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, often interacting with physicians and management staff. Responsibilities include discussing determinations with requesting providers and providing clinical rationale for standard and expedited appeals.

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Physician Clinical Reviewer- Pediatric Neurology- REMOTE

Prime Therapeutics · Full Time · 3 months ago

Prime Therapeutics

🌎 United States 💵 $90.87 - $154.33 per hour ⭐ 5-10 yrs exp 💼 Healthcare

This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, often interacting with requesting physicians and providers. Responsibilities include discussing determinations, providing clinical rationale for appeals, and ensuring documentation accuracy according to established guidelines.

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Physician Clinical Reviewer - Dermatology- REMOTE

Prime Therapeutics · Full Time · 3 months ago

Prime Therapeutics

🌎 United States 💵 $90.87 - $154.33 per hour ⭐ 5-10 yrs exp 💼 Healthcare

This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, often interacting with requesting physicians and providers. Responsibilities include discussing determinations, providing clinical rationale for appeals, and assisting Initial Clinical Reviewers.

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Physician Clinical Reviewer -Endocrinology- REMOTE

Prime Therapeutics · Full Time · 3 months ago

Prime Therapeutics

🌎 United States 💵 $90.87 - $154.33 per year ⭐ 0-2 yrs exp 💼 Healthcare

The Physician Clinical Reviewer provides timely medical review of service requests that do not initially meet medical necessity guidelines, interacting with providers and staff as needed. Responsibilities include discussing determinations with requesting physicians, providing clinical rationale for appeals, and ensuring documentation accuracy according to established guidelines.

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Physician Clinical Reviewer - Gastroenterology- REMOTE

Prime Therapeutics · Full Time · 3 months ago

Prime Therapeutics

🌎 United States 💵 $90.87 - $154.33 per hour ⭐ 5-10 yrs exp 💼 Healthcare

The Physician Clinical Reviewer provides timely medical review of service requests that do not initially meet medical necessity guidelines, interacting with providers and staff as needed. Responsibilities include reviewing complex cases, discussing determinations with requesting physicians, providing clinical rationale for appeals, and ensuring compliance with various guidelines and policies.

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Physician Clinical Reviewer-Oncologist- REMOTE

Prime Therapeutics · Full Time · 3 months ago

Prime Therapeutics

🌎 United States 💵 $90.87 - $154.33 per hour ⭐ 5-10 yrs exp 💼 Healthcare

This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, requiring routine interaction with physicians and management staff. Responsibilities include discussing determinations with requesting providers within regulatory timeframes and providing clinical rationale for standard and expedited appeals.

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Physician Clinical Reviewer - Pediatric Rheumatology- REMOTE

Prime Therapeutics · Full Time · 3 months ago

Prime Therapeutics

🌎 United States 💵 $90.87 - $154.33 per hour ⭐ 5-10 yrs exp 💼 Healthcare

The Physician Clinical Reviewer provides timely medical review of service requests that do not meet initial medical necessity guidelines, routinely interacting with physicians and staff. Responsibilities include discussing determinations with requesting providers, providing clinical rationale for appeals, and ensuring consistency using medical review guidelines.

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RVP Mid-Market Sales - Remote in TX, FL or LA

Prime Therapeutics · · 3 months ago

Prime Therapeutics

🌎 United States 💵 $108K - $184K per year ⭐ 10+ yrs exp 💼 Sales

The role is responsible for achieving sustainable sales growth within the Pharmacy Employer market by overseeing RFP responses and developing strategic sales plans and campaigns. This includes forecasting revenue, directing market-specific sales plans, and ensuring sales priorities align with operational capabilities.

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AVP Underwriting - REMOTE

Prime Therapeutics · Full Time · 4 months ago

Prime Therapeutics

🌎 United States 💵 $164K - $279K per year ⭐ 10+ yrs exp 💼 Others

The Assistant Vice President of Pricing and Underwriting leads a team to execute innovative pricing strategies and consult with clients to expand business. This role involves developing competitive contract language and pricing recommendations for RFPs.

assistant security risk-management

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