Pharmacy Part D AuditorHuntington Beach Office - Huntington Beach, CA 92647OverviewSalary Range $80,000.00 - $90,000.00 Salary Position Type Full TimeDescriptionThis position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County.Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members' culture and values.We're on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities.
At Clever Care, you'll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.Job SummaryThe Pharmacy Part D Oversight Auditor owns independent auditing and monitoring of Part D clinical compliance: CDAG (coverage determinations, exceptions, redeterminations), MTM program elements (targeting, CMR/TMR), and delegated PBM controls; ensures timeliness, accuracy, and member impact remediation are documented and audit-ready.QualificationsRequired QualificationsBachelor of Science in Pharmacy3–5+ years Part D operations/compliance auditing.Proficiency with 42 C.F.R. Part 423 Subparts D & M and current MTM expectationsDeep knowledge of:CMS Program Audit (CDAG, FA, CPE)Delegation oversight principles and evidence requirementsPart D regulatory structure and operational requirementsPreferred QualificationsPharmD or Registered Pharmacist (RPh) preferredSNP experience strongly preferredWage Range: $80,000 to $90,000 per yearPhysical & Working Environment.Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:• Must be able to travel when needed or required• Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)• Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs.Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly.Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and the public. May occasionally be required to work irregular hours based on the needs of the business.Leadership ExpectationsBy way of leadership approach, mobilize others to create extraordinary results, and unite people to turn challenges into successes by championing the following:1. Model the Way:• Clarify values by finding your voice and affirming shared values• Set the example by aligning actions with shared values2.
Inspire a Shared Vision• Envision the future by imagining exciting and ennobling possibilities• Enlist others in a common vision by appealing to shared aspirations3. Challenge the Process• Search for opportunities by seizing the initiative and looking outward for innovative ways to improve• Experiment and take risks by consistently generating small wins and learning from experience4. Enable Others to Act• Foster collaboration by building trust and facilitating relationships• Strengthen others by increasing self-determination and developing competence5. Encourage the Heart• Recognize contributions by showing appreciation for individual excellence• Celebrate the values and victories by creating a spirit of communityClever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law.
A background check is required.Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate's state residency.