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 Infusion Referral Nurse Sr – REMOTE Job Description The Infusion Referral Nurse Sr is responsible for performing referral services to support independent physician offices with maintaining member drug infusions in office or to help offices locate a lower cost alternative treatment site (e.g., home infusion) for drug infusion services versus the hospital outpatient facility. This role discusses financial and clinical considerations with members who are considering care at a higher cost treatment site, researches available financial programs to decrease members' out-of-pocket expense for drug services in office and coordinates lower cost site of service for drug administration if provider is referring due to convenience factors (e.g., distance, non-typical infusing provider, etc.). Responsibilities Provide site-of-service solutions for patients receiving care at non-preferred treatment locations, coordinating transitions to lower-cost alternatives (e.g., Hospital inpatient or outpatient facilities, non-pat cancer treatment centers, etc.) Educate members and providers on the financial impact of specialty drugs, facilitating agreement on cost-effective treatment sites Document and enter data following each case in web-based application and spreadsheets Coordinate drug infusions and related services at alternate treatment sites to reduce overall healthcare costs Support members with copay assistance programs and financial resources to minimize out-of-pocket expenses Apply clinical knowledge and critical thinking to connect members with resources that optimize treatment outcomes Maintain an active caseload, ensuring accurate documentation in web-based systems and spreadsheets in compliance with company policies and laws Validate prior authorizations and site-of-service cases, synthesizing clinical data to support product initiatives and workflows Other duties as assigned Minimum Qualifications Bachelors degree in Nursing or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or equivalent GED required 5 years of work experience in a clinical infusion setting Current Registered Nurse (RN) license to practice in the applicable state(s) Must be eligible to work in the United States without the need for work visa or residency sponsorship Additional Qualifications Ability to apply knowledge in relation to clinical findings from evidence-based guidelines Ability to function independently and as a team member Good organizational, time management and communication skills Possess the ability to achieve organizational goals through development of effective teams Comprehensive clinical knowledge of medical specialty drugs and the management of those drugs Understanding of the clinical aspect of the infusion of those drugs within various sites of service Preferred Qualifications Experience in managed care, specialty drugs, care management and utilization review 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 $74,000.00 - $118,000.00 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits). Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer. Positions will be posted for a minimum of five consecutive workdays. At Prime Therapeutics (Prime), we are a different kind of PBM. We’re reimagining pharmacy solutions to provide the care we would want for our loved ones. That purpose energizes our team and creates limitless opportunities to make a difference. We know that people make all the difference. If you’re ready for a purpose-driven career and are passionate about simplifying health care, let’s build the future of pharmacy together. Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer. If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at email Careers@primetherapeutics.com.
Prime Therapeutics is a pharmacy benefit manager (PBM) that works with independent physician offices to manage drug infusion services for members. The Infusion Referral Nurse Sr role involves coordinating referrals for patients receiving infusions, discussing financial and clinical considerations with members, researching copay assistance and financial programs to reduce out-of-pocket costs, and helping transition patients to lower-cost treatment sites such as home infusion when appropriate. This position requires educating both members and providers about the financial impact of specialty drugs and documenting cases in web-based systems.
