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PHARMACIST AUDITOR (Multiple Contractual FT Positions Available)

Clinical Pharmacist

Recruitment #24-000468-0001

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Introduction

GRADE

21

LOCATION OF POSITION

MDH Office of the Inspector General for Health, Baltimore Maryland

Main Purpose of Job

The primary purpose of this position is to assist the Program Integrity Unit of the Maryland Office of the Inspector General for Health in conducting routine Medicaid Pharmacy program audits.

The Audit Pharmacist will conduct systematic claim audits within the framework of the Maryland Medicaid Pharmacy Program (MMPP), Maryland AIDS Drug Assistance Program (MADAP), Kidney Disease Program (KDP), and Breast and Cervical Cancer Diagnosis and Treatment Program (BCCDTP). This role involves leveraging drug utilization claims data to ascertain the appropriateness of reimbursement obtained by pharmacy providers from the Maryland Medicaid program. Moreover, the Audit Pharmacist will scrutinize prescriptions for validity, ensuring compliance with relevant State and Federal rules and regulations, and confirming prescription pick-up details.

In addition to these responsibilities, the Audit Pharmacist will regularly perform calculations of claim reversal rates for all four programs, assess the usage of Coordination of Benefits codes, and identify outliers and trends. The Pharmacist will actively contribute to the identification of patterns indicative of improper activities for further investigation, encompassing questionable dispensing or prescribing practices. Proficiency in State and Federal regulations governing drug dispensing, medical supplies, medical equipment, insurance claims reimbursement policies and processes, medical terminology, and experience in regulatory compliance is imperative for success in this role. 

The positions will require frequent day and Statewide travel as part of the job.

MINIMUM QUALIFICATIONS

Education:  Graduation from an accredited School of Pharmacy with a doctorate in Pharmacy (PharmD).

Experience: One year of clinical pharmacy experience as a Registered Pharmacist.

Notes:

1. Candidates may substitute four additional years of clinical experience as a Registered Pharmacist for the required education.

2. Candidates may apply experience gained during a formal residency program to the required experience.

3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Pharmacist classifications or Pharmacist specialty codes in the Pharmacist field of work on a year-for-year basis for the required experience.

DESIRED OR PREFERRED QUALIFICATIONS

The desired candidates should possess experience in pharmacy auditing, compliance, or a related field within the pharmaceutical industry.

The desired candidates should also possess experience with: 
-Problem solving and analytical skills 
-Expertise in utilizing pharmacy management systems and software 
-Pharmacy operations, rules, regulations and health insurance processes 
-Communicating and collaborating with diverse stakeholders 
-Working independently and adeptly prioritizing tasks to ensure efficient task management 

The desired candidates should be able to exhibit exceptional attention to detail in all aspects of work and a commitment to upholding the highest standards of accuracy, ethics, and compliance.

LICENSES, REGISTRATIONS AND CERTIFICATIONS

Candidates for positions in this classification must possess a current license as a Registered Pharmacist from the Maryland State Board of Pharmacy, 4201 Patterson Avenue, Baltimore, Maryland 21215.

SPECIAL REQUIREMENTS

1. Employees in this classification are subject to call-in and, therefore, will be required to provide the facility with a phone number at which they can be reached.

2. Employees in this classification are subject to substance abuse testing in accordance with Code of Maryland Regulations 17.04.09, Testing for Illegal Use of Drugs.

SELECTION PROCESS

Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position. Therefore, it is essential that you provide complete and accurate information on your application. Please report all related education, experience, dates and hours of work. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview). 

Complete applications must be submitted by the closing date. Information submitted after this date will not be added. 

Incorrect application forms will not be accepted. Resumes will not be accepted in lieu of a completed application.

Candidates may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

BENEFITS

Contractual employees who work for an agency covered under the State Employee and Retiree Health and Welfare Benefits Program, have a current employment contract and work 30 or more hours a week (or on average 130 hours per month) may be eligible for subsidized health benefits coverage for themselves and their dependents. As a contractual employee, you will be responsible for paying 25% of the premiums for your medical and prescription coverage, including any eligible dependents you have enrolled. The State of Maryland will subsidize the remaining 75% of the cost for these benefits. You can also elect to enroll in dental coverage, accidental death and dismemberment insurance, and life insurance, but will be responsible to pay the full premium for these benefits.

Leave may be granted to a contractual employee who has worked 120 days in a 12 month period. This leave accrues at a rate of one hour for every 30 hours worked, not to exceed 40 hours per calendar year.

FURTHER INSTRUCTIONS

Online applications are highly recommended. However, if you are unable to apply online, the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201. Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

If additional information is required, the preferred method is to upload.  If you are unable to upload, please fax the requested information to 410-333-5689. Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time.

For questions regarding this recruitment, please contact the MDH Recruitment and Selection Division at 410-767-1251.

If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410-767-4850 or Application.Help@maryland.gov. 

Appropriate accommodations for individuals with disabilities are available upon request by calling: 410-767-1251 or MD TTY Relay Service 1-800-735-2258.

We thank our Veterans for their service to our country.

People with disabilities and bilingual candidates are encouraged to apply.

As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.




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