Pharmacist - Investigations

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 a 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 US.

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 investigators, 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.

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:

• Language Skills
  
  
  
  • Ability to read, analyze, and interpret common scientific and technical journals and legal documents.
  • Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.
  • Ability to effectively create and present information.
  • Ability to communicate both verbally and in writing at a professional level.
  
  
  
  

• Mathematical Skills
  
  
  
  • Ability to calculate, apply, and interpret mathematical concepts including but not limited to averages, percentages, frequency distributions, ratios, and percentiles.
  
  
  
  

• Reasoning Ability
  
  
  
  • Ability to define problems, collect data, establish facts, and draw valid conclusions.
  • Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
  
  
  
  

• Computer Skills
  
  
  
  • Intermediate or above level skills in Microsoft Word, Excel and Outlook; knowledge of Project Management software preferred.; knowledge of Project Management software preferred.
  
  
  
  

• Other Skills and Abilities
  
  
  
  • Ability to work independently with appropriate coordination among project staff, partners and customers.
  • Strong project management experience.
  • Highly organized, able to work in a fast-paced environment, able to juggle multiple projects and assign proper priority, able to switch among tasks quickly and calmly.
  • Excellent interpersonal skills and ability to work with and through people to get the job done.
  • Assertive and diplomatic; able to establish credibility very quickly.
  • Ability to develop and maintain long term working relationships.
  • Accurate, thorough, detail oriented with excellent follow-through.
  
  
  
  

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 telehealth experience is a plus.
• Intermediate-level and above ability to use Excel is required. An Excel skills test may be requested. This position also requires the ability to use Word and Outlook.
• 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.

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