Pharmacist SME – Medicare Part D
- Job Title
- Pharmacist SME – Medicare Part D
- Job ID
- 27744901
- Work Remote
- Yes
- Location
- Remote
- Other Location
- Description
-
Pharmacist SME – Medicare Part D
Work from Home within the Continental United States
@Orchard LLC is supporting a not-for-profit corporation that partners with public and private sectors to create high-quality, safe, and efficient delivery of health care and human services programs. Our client has multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Our client is also a national leader in fighting fraud, waste, and abuse for large organizations across the country. In addition, our client operates a foundation providing grant opportunities to those with programs for under-served communities.
We have an exciting opportunity for a Pharmacist with Medicare Part D experience preferably in a Managed Care/Provider Benefit Manager setting. Experience related to Medicaid, fraud investigation, medical testimony, law enforcement referrals or investigations, and/or compounding and wholesalers/inventory management is preferred as well. This position is great fit for pharmacists who enjoy working with data and using their strong problem-solving skills. Retail-only experience is not a good fit for this position. Well qualified candidates will possess strong writing skills as well as intermediate-level or better Excel skills. This position can be home-based in most areas of the continental U.S.
This team of Pharmacists support the Client’s Investigations MEDIC contract in the detection and prevention of Medicare Part C and Part D fraud, waste, and abuse. This position will serve as a subject matter expert in assisting auditors, data analysts, and other designated staff conducting data and investigative analysis. The Pharmacist may lead projects involving the proactive identification of vulnerabilities and data analysis to identify and detect fraud, waste, and abuse. They are responsible for facilitating and managing assigned projects and contracts relating to pharmacy services. Leads and provides oversight to assigned tasks and contracts, making sure that contract specifications are understood, tasks are assigned appropriately, and information is available and circulated.
Essential Duties and Responsibilities include the following:- Manages the day-to-day operations of assigned projects, as well as inter-project and cross-setting coordination of resources among projects; and contracts including facilitation and communication of resolution of barriers.
- Prioritizes, delegates, and accomplishes tasks and programs independently and in a team to ensure successful implementation of goals and objectives.
- Works with the appropriate stakeholders, drug plans, prescribers, and pharmacies within the pharmacy community to: build partnerships, support data sharing, develop tools and references to support changes in care practices in the pharmacy arena.
- Reviews and interprets contract deliverables to ensure timely and accurate completion.
- Leads the design and application of work plans, as well as coordinating their evaluation and any needed modifications to ensure they reflect project work.
- Contributes to the conceptual design and implementation of projects, as well as assist with project execution as needed.
- Ensures all project deliverables and timelines are met and reports on variances in a timely manner.
- May provide educational programs as necessary to meet project goals and promote high quality, safe, and effective medication use.
- May contribute newsletter articles applicable to project goals and community needs/requests; contributes abstracts for submission to national pharmacy, medical, and quality organizations; submit written manuscripts, as appropriate, to pharmacy, medical, and quality care journals for publication.
- May contribute professional presentations at national pharmacy, medical, and quality organization meetings.
Your background will include.- Registered pharmacist, Bachelor’s degree in pharmacy, with Master's degree in pharmacy or Pharm.D.
- Degree with three to five years’ experience in practice (retail, health-systems, consulting, industry or academia).
- Medicare Part D Plan, managed care plans, or PBM experience strongly preferred.
- Experience in areas such as coverage determination, administration of formularies, auditing claims for payments of pharmacy benefits required.
- Compounding and/or tele prescribing experience is a plus.
- Intermediate-level and above ability to use Excel is required.
- Writing skills sufficient to ensure timely and accurate completion of contract deliverables. A writing sample may be requested.
Certificates, Licenses, Registrations:- Active, current and non-restricted Registered Pharmacist (RPh) license in the areas required by the contract.
If you match the requirements for this opportunity and believe you have the experience and talent to succeed in the role, we need to hear from you!
Established in 2010, @Orchard LLC, also known as, Talent Orchard has an exceptional reputation, providing staffing solutions to time-sensitive, talent scarcity issues to deliver better talent management ROI. Our specialty lies in the critical area of program talent acquisition and resource management, not in one narrow skillset, but across many areas of technical and functional delivery. To learn more about our other exciting opportunities, visit our Jobs Page at www.atOrchard.com.
