SME Pharmacist - Medicare Part D

Qlarant 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 have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.

Best People, Best Solutions, Best Results

Job Summary:

Qlarant has 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 and will possess strong writing skills as well as intermediate-level or better Excel skills. Our Pharmacists support Qlarant'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. This position can be home-based in most areas of the continental US.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• 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.

To perform the job successfully, an individual should demonstrate the following competencies:

• Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses experience to complement data.
• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully.
• Project Management - Develops project plans; Coordinates projects; Communicates changes and progress; Completes projects on time; Manages project team activities.
• Leadership - Inspires and motivates others to perform well; effectively influences actions and opinions of others.
• Quality Management - Looks for ways to improve and promote quality.
• Judgment - Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process.
• Planning/Organizing - Prioritizes and plans work activities; Plans for additional resources; Develops realistic action plans.

Education and/or Experience:

• 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 or PBM experience strongly preferred.
• Prior experience with medical testimony, law enforcement referrals or investigations, wholesalers/inventory management preferred.
• Medicaid experience is a plus.
• Compounding and/or tele prescribing experience is a plus.

Certificates, Licenses, Registrations:

• Active, current and non-restricted Registered Pharmacist (RPh) license in the areas required by the contract.

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.