Pharmacy Program Integrity Manager

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