Travel to participating Network Pharmacies to observe pharmacy practices and review documentation in accordance with department audit procedures.
Analyze individual pharmacy claims and conduct claims reviews while onsite at the pharmacy to ensure compliance with contractual and regulatory obligations; Identify and escalate potential non-compliant, suspicious, or fraudulent pharmacy activity management and/or Primes SIU for further investigation and review
- Experience 5-10 year(s)
- Positions 1
- Industry /