Integrated Pharmacy Solutions (IPS) is seeking a licensed pharmacist to perform clinical quality assurance review of PBM pharmacy claims audits. Working as the second-level reviewer, you'll evaluate preliminary discrepancies flagged by our technician auditors, apply clinical and regulatory judgment to validate each finding, and finalize audit results before they are conveyed to the audited pharmacy. This is a review and validation role — you are the clinical checkpoint that ensures every discrepancy is accurate, defensible, and appropriately documented before release.Key Responsibilities
- Review technician-flagged claim discrepancies and clinically validate or overturn each finding
- Apply knowledge of pharmacy practice, billing, and PBM audit criteria to assess whether flagged claims represent true discrepancies
- Ensure audit findings are accurate, well-documented, and defensible prior to communication to the pharmacy
- Provide clinical guidance to technician auditors and help refine flagging criteria over time
- Maintain confidentiality, compliance, and quality standards across all audit work
Qualifications
- Active pharmacist license in good standing (any U.S. state)
- Minimum 5 years of pharmacy experience
- Breadth of practice experience strongly preferred — candidates with a background spanning multiple settings (e.g., long-term care, retail/ambulatory, mail-service, specialty, clinic, and hospital pharmacy) will be prioritized over those with a single-setting background, as diverse exposure sharpens the clinical judgment this review role depends on
- Strong attention to detail and clear, defensible documentation skills
- Prior audit, claims, or PBM experience a plus
Work Arrangement
Hybrid position based out of our Melrose, Massachusetts office. Approximately 2 days per week in-office with the remaining 3 days remote.
Pay: $60.00 - $65.00 per hour
Work Location: Hybrid remote in Melrose, MA 02176
