Provider Educator - Remote in California

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 Provider Educator - Remote in California Job Description 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. Responsibilities + 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. + Conducts provider site visits and audits, or desk audits, in collaboration with Quality Improvement staff. + 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. Minimum Qualifications + A Combination of Education and Work Experience May Be Considered. + Bachelors - Healthcare + 2+ years Pharmacy + 2+ years Healthcare Must be eligible to work in the United States without the need for work visa or residency sponsorship Additional Qualifications + 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. Preferred Qualifications + CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy 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. Potential pay for this position ranges from $25.48 - $40.87 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page ( and click on the

Created: 2026-02-26