• Pharmacy Specialist

    Job ID 2018-2697
    Job Locations
    US-Remote | US-OH-Grove City
    Category
    Healthcare / Biotechnology
    Type
    Casual
  • Overview

    NCI is a leading provider of enterprise solutions and services to U.S. defense, intelligence, health and civilian government agencies. Coupled with a refined focus on strategic partnerships, we are successfully bridging the gap between commercial best practices and mission-critical government processes. Core competencies include:

    • Artificial intelligence
    • Agile digital transformation
    • Advanced analytics
    • Hyperconverged infrastructure solutions
    • Cyber security and information assurance
    • Fraud, waste and abuse
    • Engineering and logistics

    MF18

    NCI has been designated a 2018 Military Friendly Employer by MilitaryFriendly.com 

     

    Headquartered in Reston, Virginia, NCI has approximately 2,000 employees operating at more than 100 locations worldwide.

    Responsibilities

    ESSENTIAL FUNCTIONS:

     

    • Extensive knowledge of how prescription drugs are developed and managed
    • Experience in the development of plans and the review of claims to ensure clinically appropriate utilization, including experience in claims analysis, claims data review for abnormalities, auditing of claims, and setting up edits and audits to ensure proper utilization of benefits
    • Experience concerning the current uses of medications, new or emerging issues, issues related to electronic prescribing, among other general knowledge and experience in prescription drug benefits
    • Assists the Data Analysis, Program Integrity, Medical Review and Request for Information Managers and Supervisors by researching Medicare and Medicaid pharmaceutical drug coverage criteria, regulations and policies as requested
    • Proactively seeks out and develops Medicare and Medicaid pharmaceutical fraud or abuse leads from various sources including Center for Medicare Services (CMS), state Medicaid agencies, law enforcement, fraud alerts or other sources
    • Stays current with Medicare and Medicaid fraud/abuse issues or vulnerabilities related to pharmaceuticals and recommends appropriate proactive analysis
    • Assists Data Analysis team in development of proactive or reactive data analysis for pharmaceutical related issues
    • Assists the Program Integrity team in investigations related to pharmaceutical claims
    • Assists the Medical Review team in the review of pharmaceutical claims
    • Develops and conducts internal and external training as assigned by management
    • Assists with training for internal and external stake-holders
    • Provides expert witness testimony as required
    • Travels as required for meetings or training
    • Conducts research on pharmacy related algorithms as requested to identify clinical implications of the algorithm
    • Conducts state-specific research for applicable pharmacy policies as requested
    • Provides support and assistance to Statisticians, Medicaid Specialists, Research Analysts and Data Analysts in the development and execution of algorithms and models
    • Demonstrates knowledge and ability to research standard pharmacy practices, and Medicaid rules and policies for the applicable states
    • Actively participates in Data Oversight Committee meetings when applicable
    • Performs other duties as assigned by Operations Manager that contribute to various – task order area – goals and objectives and comply with Centers for Medicare-Medicaid Services (CMS) directives and regulations
    • Ensures confidentiality of all Protected Health Information (PHI) and sensitive information
    • Demonstrates communication skills with internal and external customers, including Senior Management, (CMS) team and State Medicaid officials

    Qualifications

    MINIMUM REQUIREMENTS:

    • Bachelor’s Degree of Pharmacy and shall be a board-trained certified pharmacist and trained in Biochemistry, Chemistry and Pharmacokinetics
    • At least five (5) years experience in prescription drug benefit management with three (3) years experience managing a prescription drug formulary, medication therapy management, and drug interaction program
    • Must maintain licensure as a pharmacist
    • Associate must have and maintain a valid driver's license issued by his/her state of residence

     

    EXPERIENCE REQUIRED:

    • 4 - 9 Years

     

    PREFERRED EDUCATION AND EXPERIENCE:

    • Doctorate of Pharmacy (Pharm. D) preferred

     

    PHYSICAL REQUIREMENTS:

     

    This position requires the ability to perform the below essential functions:

    • Sitting for long periods
    • Standing for long periods
    • Ambulate throughout an office
    • Ambulate between several buildings
    • Stoop, kneel, crouch, or crawl as required
    • Repeatedly lift and carry weight up to ___ pounds
    • Travel by land or air transportation ___ %

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