Pharmacy Specialist - REMOTE 

The Pharmacy Specialist will perform in-depth evaluation and analysis of potential pharmaceutical fraud, waste, or abuse investigations and requests for information using claims information, medical records, and other sources of data. Provide subject matter expertise and technical assistance on matters related to pharmaceutical billing to Medicare and Medicaid. Support the Data Analysis, Program Integrity, Medical Review, and Law Enforcement Coordination teams by consultation with staff and by participating in investigative and/or data analysis efforts. Provide assistance in developing proactive data analysis.

In assuming this position, you will be a critical contributor to meeting CoventBridge Group's objective:  To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse.

This position will report directly to the Medical Director and will work in our Grove City, OH office, or if not local, remotely from a home office. 

Responsibilities:

• Assist the Data Analysis, Program Integrity, Medical Review and Law Enforcement Coordination Team Managers and Supervisors by researching Medicare and Medicaid pharmaceutical drug coverage criteria, regulations and policies as requested
• Proactively seek out and develop Medicare and Medicaid pharmaceutical fraud or abuse leads from various sources including CMS, state Medicaid agencies, law enforcement, fraud alerts, or other sources
• Maintain current knowledge of Medicare and Medicaid fraud/abuse issues or vulnerabilities related to pharmaceuticals and recommend appropriate proactive analysis
• Assist the Data Analysis team in developing proactive or reactive data analysis for pharmaceutical related issues
• Assist the Program Integrity team in investigations related to pharmaceutical claims
• Assist the Medical Review team in the review of pharmaceutical claims
• Develop and conduct internal and external training as assigned by management. Assist with training for internal and external stakeholders.
• Provide expert witness testimony as required
• Travel as required for meetings or training
• Perform other duties as assigned

Requirements:

• Must maintain licensure as a pharmacist
• Highly proficient with Microsoft Excel and Word
• Working knowledge of Microsoft Access and PowerPoint, high proficiency with Access is a plus.
• Excellent verbal and written communication skills
• Excellent research skills including internet research
• Ability to work independently with minimal supervision
• Ability to perform multiple priority tasks

Educational/Experience Qualifications:

• Bachelor’s Degree in Pharmacy. A Doctor of Pharmacy is preferred.
• A minimum of five years of experience as a pharmacist
• Knowledge and experience concerning the current uses of medications, new or emerging issues and issues related to electronic prescribing among other general knowledge and experience in the prescription drug benefits
• Demonstrated experience analyzing large data sets and producing reports is preferred

• Medical, Dental, Vision plans
• Life, LTD and STD paid by the employer
• 401(k) with company match up to 4%
• Paid Time Off and company paid holidays
• Tuition assistance after 1 year of service

The salary range for this role is $120,000 to $130,000 annually.  This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future.  An employee’s pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs.  

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

About Us:

CoventBridge Group is the global leader in full-service investigations providing Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs.  The company provides top tier data privacy and security practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage via its 1000 employees and affiliates worldwide.

CoventBridge is an equal opportunity employer.  We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace.

CoventBridge is committed to the full inclusion of all qualified individuals.  As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com.