At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

Job Description

The Principal of Health Individual Marketplace Strategies leads the development and execution of integration and profitability strategies for clients participating in the Individual and Small Group Exchanges under the Affordable Care Act. This position ensures quality and compliance standards are met while driving successful capability development and execution of the strategies, in support of one or more of Prime's market segments by evaluating market performance of benefits, market share, and competitive position to develop recommendations for improvements to support client strategic goals.

Responsibilities

• Collaborate with leadership to identify, develop and optimize segment-specific strategies to ensure Individual Marketplace growth for Health Plan accounts
• Partner with Segment Client Engagement team to review client performance metrics, market analysis, and client best practices to provide client specific recommendations for segment success
• Work with Health Plan clients to ensure short and long-term product performance goals are met, including, but not limited to membership growth, market share and profitability, and benefit designs
• Partner with Compliance and Government Affairs to understand, interpret and effectively communicate complex regulatory policies and contract obligations relevant to the segment, ensuring alignment and informed decision-making
• Ensure timely and accurate development and implementation of federal and state regulatory milestones, deliverables, and requirement changes for assigned Health Plan clients, maintaining compliance and supporting operational readiness
• Collaborate with various business units, cross-functional teams and key stakeholders to ensure timely, accurate and on budget implementation of programs
• Develop and deliver executive-level presentations that communicate business objectives, project status, key challenges and achievements
• Other duties as assigned

Minimum Qualifications

• Bachelor's degree in Finance, Business, Health Care Administration, or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required

• 7 years of work experience in analytics, account management, product development, project management or consultative roles within healthcare, PBM, specialty pharmacy, health care consulting or other highly regulated industry

Additional Qualifications

• Ability to work effectively in self-directed environment
• Must possess strong interpersonal skills and demonstrate exemplary public speaking, verbal and written communication abilities
• Ability to influence and present complex data to a wide variety of audiences, including internal and external executives
• Exceptional client relationship management and cross-functional team building skills
• Skilled collaborator with proven ability to reconcile differing perspectives and drive mutually beneficial outcomes
• Advanced business acumen and critical thinking skills

Preferred Qualifications

• Experience in ACA/Health Care Exchange business or other Government Programs lines of business
• Managed care experience
• Experience in Project Management/Ownership
• Experience with analytic tools like SQL programming, GCP, SAS, and visualization tools like Tableau

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job