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
Pharmacist III in workfromhome at Unknown Company
This position is listed as contract and able to be worked remotely.