Pharmacist III
Job Summary
To support healthcare integrity efforts, the full-time remote Pharmacist III will review beneficiary and provider cases for potential overpayment and fraud, conduct audits, and provide clinical expertise to investigations.
Key responsibilities
- Review beneficiary, provider, and pharmacy cases for potential overpayment, fraud, waste, and abuse
- Conduct desk reviews or field audits to meet contract requirements and identify evidence of fraud
- Provide clinical input as a Subject Matter Expert for program integrity and medical review teams
Required qualifications
- Doctor of Pharmacy (PharmD) degree
- 5+ years of experience in a Lead or Supervisor role
- Experience in conducting medical reviews and audits
- Ability to consult with benefit integrity investigation experts
- Familiarity with legal proceedings related to healthcare investigations
Complete Job Description
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