Remote Part D Pharmacy Auditor: Impact & Compliance

JobRx, Inc.; Huntington Beach (CA); Hybrid; USD 80,000 - 90,000; Full time

Job summary

Clever Care Health Plan is seeking a Pharmacy Part D Oversight Auditor to lead independent auditing of Part D compliance, MTM program elements, and delegated PBM controls. You will ensure timeliness, accuracy, and remediation as audit-ready deliverables.

The role involves travel as needed and a mix of office and remote work. Qualifications include a BS in Pharmacy and 3–5+ years in Part D operations or compliance auditing, with strong knowledge of CMS rules and MTM expectations.

Qualifications

• Bachelor of Science in Pharmacy required.
• 3–5+ years in Part D operations or compliance auditing.
• Proficiency with 42 C.F.R. Part 423 Subparts D & M and MTM expectations.
• Deep knowledge of CMS Program Audit and delegation oversight.

Responsibilities

• Audit coverage determinations and redeterminations timeliness and content.
• Validate MTM targeting, CMR/TMR completion, CMS submissions.
• Monitor delegated PBM and pharmacy FDRs for policy compliance.
• Coordinate with UM/Part C on benefit coordination affecting access.
• Prepare CDAG/MTM dashboards and Board reports.

Skills

Part D operations auditing

MTM knowledge

Regulatory compliance

Education

Bachelor of Science in Pharmacy

Job description

Clever Care Health Plan is seeking a Pharmacy Part D Oversight Auditor to lead independent auditing of Part D compliance, MTM program elements, and delegated PBM controls. You will ensure timeliness, accuracy, and remediation as audit-ready deliverables.

The role involves travel as needed and a mix of office and remote work. Qualifications include a BS in Pharmacy and 3–5+ years in Part D operations or compliance auditing, with strong knowledge of CMS rules and MTM expectations.