Pharmacy Compliance & Audit Program Lead

100 Horizon Healthcare Services, Inc; Hopewell (NJ); Hybrid; USD 110,000 - 150,000; Full time

Benefits offered by this job

Health benefits

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey seeks a seasoned Pharmacist to lead Pharmacy Fraud, Waste and Abuse programs and collaborate with regulators. The role includes clinical oversight with auditing vendors and on-site audits, plus designing utilization management edits.

You will bring a NJ Pharmacist license, 5+ years of practice, and 3+ years in pharmacy auditing. Hybrid schedule with NJ travel and competitive benefits.

Qualifications

• Bachelor degree in Pharmacy or Pharm D from an accredited college or university.
• Active NJ Pharmacist License required.
• Minimum of 5 years as a Registered Pharmacist in retail, PBM, managed care or auditing.
• Minimum of 3 years pharmacy auditing experience.

Responsibilities

• Lead all program efforts and regulatory collaboration for Pharmacy Fraud, Waste and Abuse.
• Oversee clinical oversight with the pharmacy audit vendor and site selection for on-site audits.
• Design utilization management programming edits.

Education

Bachelor degree in Pharmacy or Pharm D

Active NJ Pharmacist License

Pharmacy auditing experience

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks a seasoned Pharmacist to lead Pharmacy Fraud, Waste and Abuse programs and collaborate with regulators. The role includes clinical oversight with auditing vendors and on-site audits, plus designing utilization management edits.

You will bring a NJ Pharmacist license, 5+ years of practice, and 3+ years in pharmacy auditing. Hybrid schedule with NJ travel and competitive benefits.