Pharmacy Program Integrity Manager

Job Summary

A company is looking for a Pharmacy Program Integrity Development Lead.

Key Responsibilities

• Lead the design and execution of the multi-year strategic roadmap for the Pharmacy Fraud, Waste, and Abuse (FWA) program
• Analyze integrated medical and pharmacy data to detect patterns of abnormal utilization and emerging fraud schemes
• Prepare and present regular reports to Executive Leadership on program ROI, regulatory risk exposure, and strategic direction

Required Qualifications

• Bachelor's degree and a minimum of 6+ years of experience in Pharmacy Benefit Management (PBM) or Health Plan FWA/Payment Integrity
• Expert-level knowledge of Medicare Part B/D claims processing and CMS FWA requirements
• Ability to multitask and drive outcomes across cross-functional teams
• Experience in analyzing large datasets using SQL
• Clinical credentials (e.g., Pharmacist, CPhT) are a plus