jazzhr
Pharmacist III
J29, Inc
Remote, USA
Full-time
Senior Level
Remote
Discovered 1 weeks ago
Free
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- Reviews beneficiary, provider, and/or pharmacy cases for potential overpayment, fraud, waste, and abuse.
- Completes desk review or field audits to meet applicable contract requirements and to identify evidence of potential overpayment or fraud.
- Consults with benefit integrity investigation experts and pharmacists for advice and clarification.
- Completes case summaries and provides results to investigators to support the investigative process.
- Provides case specific or plan specific data entry and reporting.
- Participates in internal and external focus groups, as required.
- Participates in provider onsite visits and beneficiary interviews, as required, for field audits/investigations.
- Testifies at various legal proceedings, as necessary.
- Provides job-specific orientation and training, as needed. Helps develop training content, resources, and programs specific to job functions.
- Conducts medical review on a variety of service types.
- Provides clinical input as a Subject Matter Expert for the program integrity, medical review, and data teams.
- Doctor of Pharmacy (PharmD)
- 5+ years of experience in a Lead or Supervisor role.
About J29, Inc
Management Consulting102 employeesFounded 2017
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