Pharmacy Investigations Manager
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Job Summary
Leading the pharmacy Fraud, Waste, and Abuse (FWA) investigations program, the full-time remote Pharmacy Investigations Manager will manage complex investigations, develop a high-performing team, and ensure compliance with regulatory standards while serving as a trusted advisor to various stakeholders.
Key responsibilities
- Oversee the intake, triage, case assignment, and resolution of pharmacy investigations
- Develop and maintain a risk-based investigative framework aligned with federal and state requirements
- Prepare executive-ready reports and presentations detailing investigative findings and recommended actions
Required qualifications
- At least 5 years of healthcare fraud investigation experience, specifically in pharmacy investigations
- Proven leadership experience in managing investigative teams and driving complex matters to resolution
- Strong knowledge of pharmacy claims, PBM operations, and applicable laws such as the False Claims Act
- Bachelor's degree in healthcare, criminal justice, compliance, business, or a related field
- Relevant certifications such as AHFI, CFE, or pharmacy technician certification are required
Complete Job Description
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