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CLINICAL PHARMACIST

Reviewing Pharmacist

Recruitment #19-000468-0001

GRADE

19

LOCATION OF POSITION

MDH, Office of the Inspector General, Baltimore, MD

Main Purpose of Job

The main purpose of this position is to assist the Program Integrity Unit of the Office of the Inspector General to identify fraud, waste, and abuse especially involving Medicaid reimbursed pharmacy prescriptions, durable medical equipment (DME) and supplies. This position will assist in conducting audits and investigations of health care providers, including clinicians, pharmacies, and suppliers of durable medical equipment/supplies who are suspected of receiving payments from the Maryland Medicaid program for goods or services not provided in accordance with regulations. In this position, findings of fraud, waste and/or abuse may result in administrative actions or referral to the Office of the Attorney General, Medicaid Fraud Control Unit for civil or criminal prosecution. This position also collaborates with analysts in the OIG Data Unit to conduct data mining for identifying billing anomalies, monitoring services, and to discover other patterns or relationships of possible fraud paid by the Medicaid program. The incumbent will identify from the data mining Medicaid providers suspicious of committing fraud, waste and/or abuse and request pertinent claims and medical records to be reviewed. The incumbent will determine if the provider is improperly obtaining reimbursement from the Medicaid program. In this position, knowledge of State and Federal regulations governing the dispensing of drugs, and medical supplies and equipment, insurance claims reimbursement policies and processes, medical terminology, and experience in regulatory compliance is essential.

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 preferred candidate should possess the following:

  • supervision/management of a retail pharmacy
  • knowledge of Billing compliance regulations, fee schedules and industry standards
  • familiar with Medicaid and Kidney Disease Program (KDP)
  • experience identifying aberrant drug utilization
  • experience identifying atypical medication dispensing by pharmacies and medical providers

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. Please submit a copy of your license or license number with your application.

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

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.