Qlarant, Inc., is 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. We're a national leader in fighting fraud, waste and abuse for large organizations across the country.
Qlarant's Investigations MEDIC contract has an immediate opening for a Pharmacy Subject Matter Expert. This is a mid-level professional position that does not require a Pharmacist license. It's a perfect position for an experienced Pharmacy Tech with expertise in Medicare Part D, inventory management, and fraud investigation / pharmacy audit. As a member of our Investigative MEDIC team, you will work in concert with our pharmacists, data analysts and investigators to detect and prevent fraud, waste and abuse in the Medicare Part C and Part D programs.
This position could be based in our Baltimore, MD office or home-based in most areas of the country for well qualified candidates.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
Collaborates with the customer to design and adapt processes and deliverables to meet changing needs.
Provides relevant pharmacy data and billing training to Analysts and Investigators.
Serves as subject matter expert to internal and external investigators on pharmacy processes, ordering, and billing.
Assists in the development, evaluation process, and implementation of policies, procedures, and training/education modules relating to pharmacy team deliverables.
Participates in targeted/strike force reviews and intelligence targeting. Assists data teams in regards to pharmacy data.
Interfaces significantly with internal investigators and external law enforcement personnel.
Supports ongoing customer relationships and development of new initiatives.
Assists pharmacy team in ensuring contract work is delivered timely and meets quality standards.
May assist in the implementation of new contracts and responds to RFP process as needed.
Identifies opportunities for improvement; assists teams in developing and implementing improvement strategies.
To perform the job successfully, an individual should demonstrate the following competencies:
Bachelor's degree in a relevant field preferred, extensive experience in the field; or equivalent combination of education and experience.
Must possess the ability to interact with all levels of personnel.
Registered or Certified Pharmacy Technician required.
Three years or more pharmacy experience, with inventory management experience preferred.
Medicare Part D experience preferred.
Fraud investigation and/or pharmacy audit experience preferred.
Intermediate to advanced knowledge of Excel preferred.
Data analytics experience preferred.
Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.