Remote New

SME Pharmacist V - Medicare Part D

Qlarant
$105,749.00 - $153,000.00
United States, California, Cerritos
17785 Center Court Drive North (Show on map)
Aug 22, 2025
SME Pharmacist V - Medicare Part D Job Location Remote Position Type Full-Time/Regular 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. * Provides oversight and education in their assigned area/specialty. * Provides mentorship to junior level employees, including quality oversight of delegated tasks. * 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 to build partnerships, support data sharing, and 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 coordinates their evaluation and any needed modifications, to ensure they reflect project work. * Leads the conceptual design and implementation of projects, as well as ensures project execution as needed. * Ensures all project deliverables and timelines are met and reports on variances in a timely manner. * Participates in trial sessions, to include direct contact with prosecutors and/or LE, and testifies at various legal proceedings or administrative hearings, as necessary. Provides subject matter expertise related to pharmacy practice and/or relevant policy to the client and the client's agencies, including law enforcement. * Provides educational programs, as necessary, to meet project goals. Contributes professional presentations at pharmacy, medical, and quality organization meetings. * Contributes newsletter articles applicable to project goals and community needs/requests; contributes abstracts for submission to pharmacy, medical, and quality organizations; and submits memos or reports, as appropriate. Required Skills To perform the job successfully, an individual should demonstrate the following competencies: Business Expertise- Good knowledge of how own discipline contributes to the Company and good understanding of competitors (products/services). Problem Solving- Requires complex judgment based on advanced analytical thought. Nature of Impact- Provides input to strategy within own discipline. Area of Impact- Primarily on a Business Area. Interpersonal Skills- Developed communication skills, ability to negotiate mainly internally and often at higher levels. Leadership- Allocates/coordinates work within the team/project and/or contributes to technical/professional direction for a discipline. Functional Knowledge- Expert in a discipline. Project Management- Senior project/program team member responsible for work flow which is varied in nature with situations frequently requiring new solutions. Required Experience Education and/or Experience: Bachelor's of Pharmacy and 12-14 years of experience required (experience can be substituted for education)Work E Master's Degree or PharmD with 15+ years of 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 preferred. Formulary administration experience is preferred. 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. Salary Range $105,749.00 - $153,000.00