Pharmacy Program Integrity ManagerVirtualVocations • Sugar Land, Texas, United States
Pharmacy Program Integrity Manager
VirtualVocations • Sugar Land, Texas, United States
[job_card.variable_hours_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]
A company is looking for a Pharmacy Program Integrity Development Lead.
Key Responsibilities
Lead the design and execution of the multi-year strategic roadmap for the Pharmacy Fraud, Waste, and Abuse (FWA) program
Analyze integrated medical and pharmacy data to detect patterns of abnormal utilization and emerging fraud schemes
Prepare and present regular reports to Executive Leadership on program ROI, regulatory risk exposure, and strategic direction
Required Qualifications
Bachelor's degree and a minimum of 6+ years of experience in Pharmacy Benefit Management (PBM) or Health Plan FWA / Payment Integrity
Expert-level knowledge of Medicare Part B / D claims processing and CMS FWA requirements
Ability to multitask and drive outcomes across cross-functional teams
Experience in analyzing large datasets using SQL
Clinical credentials (e.g., Pharmacist, CPhT) are a plus
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