The Pharmacist III reviews medical claims and pharmacy cases to identify potential fraud, waste, and abuse through desk reviews and field audits. They also provide clinical expertise as a subject matter expert and support investigative processes through case summaries and legal testimony.
This position is contingent upon the successful award of the associated contract. Employment is not guaranteed until the contract is awarded, and the position is officially activated. Job responsibilities and requirements are subject to change.
Position: Pharmacist III Location: Remote
About J29 J29 is an employee centered healthcare management consulting company that specializes in processing, reviewing, and analyzing medical claims, records, disputes, and audits. Established in 2017, J29 prides itself on its employee centric culture and high employee retention rates that allow us to ensure that we are creating a working environment that prioritizes the employee experience. Our team brings corporate performance that stretches to various areas where we can provide our clinical, healthcare policy, and compliance expertise through our support to health and human service programs at the State, Federal, and Commercial levels. Role & Responsibilities
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.
Experience / Expertise
Doctor of Pharmacy (PharmD)
5+ years of experience in a Lead or Supervisor role.
J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. J29, Inc. is a proud Veteran friendly employer.
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