68064819 - SENIOR PHARMACIST

Requisition No: 838665 

Agency: Agency for Health Care Administration

Working Title: 68064819 - SENIOR PHARMACIST

 Pay Plan: Career Service

Position Number: 68064819 

Salary:  $3,638.23 - $3,820.98 biweekly 

Posting Closing Date: 10/16/2024 

Total Compensation Estimator Tool

Agency Overview:

The Agency for Health Care Administration is Florida's chief health policy and planning entity. The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000 health care facilities, and empowering consumers through health care transparency initiatives.

This is a full-time Career Service (CS) position, with regularly scheduled hours of Monday-Friday 8:00 a.m. to 5 p.m.  This Senior Pharmacist is anticipated to be filled at a rate of $3,638.23 - 3,820.98 biweekly/non-negotiable, based upon the selected candidate's qualifications and experience.  This position may involve travel related activities from 1-25%.  Successful completion of a criminal background investigation is a condition of employment.

Position Overview:

The Florida Medicaid program is one of the five largest in the country and has an estimated $35 billion annual budget. Each month Florida Medicaid covers medical services for almost 4 million recipients. To effectively serve this large patient population, one of the Agency goals is to ensure fewer budgeted dollars are lost to fraud, abuse, and waste. The Bureau of Medicaid Program Integrity (MPI) does this specifically through audits and investigations of Medicaid providers, including managed care plans. MPI also imposes administrative sanctions for program violations and refers suspected fraud or other criminal violations to appropriate law enforcement agencies for further investigation.

MPI operates with dynamic and fast-paced units that work closely together to serve the overall bureau mission.  MPI units are responsible for developing novel methods and innovative solutions necessary to address the complexity and scope of fraudulent and abusive behavior in the Florida Medicaid program. These highly collaborative units rely on teams with diverse educational and experience backgrounds.

Each of MPI’s Overpayment Recovery Units (ORU) identify improper Medicaid payments by performing comprehensive audits and generalized analyses. MPI uses accepted and valid auditing procedures that include statistical methodologies. As appropriate, the ORUs also conduct non-extrapolated claim-by-claim reviews, invoice purchase verification reviews, and policy-based claims reviews. ORUs perform both claim reviews and prepayment reviews. They also make policy or payment program edit recommendations and assist with the litigation process to defend state audits. The ORUs are organized primarily by the types of Medicaid providers each unit audits.

This position is in the Pharmacy and Durable Medical Equipment Unit which conducts audits primarily of non-institutional types of providers such as pharmacies and DME providers.  The selected candidate will be responsible for conducting audits, writing summary reports, and issuing audit reports in accordance with state and federal rules, laws, and statutes.  Additionally, the selected candidate will be responsible for working collaboratively with team members and managers in other MPI operational units and participating in special projects. 

This position requires a broad array of knowledge and experience specifically related to fraud prevention programs, compliance assessment, legal analysis, and the investigative process as well as a desire to innovate. The selected candidate will assist in conducting investigations related to fraud, abuse, and waste through research and analysis of complex health and business-related data. 

Included in the functions of this position are activities such as:

•Utilizing open-source and proprietary resources to conduct the investigations and related administrative actions, as well as monitoring and tracking the associated case status.

•Preparing referrals to law enforcement entities.

•Identifying, analyzing, and interpreting trends or patterns in data sets, as well as other investigative and research tools.

•Collaborating with team members on projects and assignments.

•Conducting payment restriction reviews in accordance with state and federal rules, laws, and statutes.

Benefits of Working for the State of Florida:

Working for the State of Florida is more than a paycheck. The State’s total compensation package for employees features a highly competitive set of employee benefits including:

     •      State Group Insurance Coverage Options, including health, life, dental, vision, and other  supplemental insurance options;

     •      Flexible Spending Accounts;

     •      State of Florida retirement options, including employer contributions;

     •      Generous annual and sick leave benefits;

     •      9 paid holidays a year and 1 Personal Holiday each year;

     •      Career advancement opportunities;

     •      Tuition waiver for courses offered by Florida’s nationally ranked State University System ;

     •      Training and professional development opportunities;

     •      And more!

For more information, please visit MPI at: http://ahca.myflorida.com/MCHQ/MPI/index.shtml

KNOWLEDGE, SKILLS, AND ABILITIES

Knowledge of the principles, practices, standards, and terminology used in the practice of pharmacy.

Knowledge of drug properties and usage including the effects of drug interactions.

Knowledge of the Florida Medicaid Program.

Knowledge of Microsoft features including, Word, Excel, Outlook, and Internet Explorer.

Knowledge of research or investigative principles, practices, and techniques.

Knowledge of various specialty provider types practices.

Knowledge in inventories and inventory control.

Ability to evaluate drug therapy against set criteria.

Ability to develop program policy manuals, rules, and program monitoring methodologies, techniques, and plans.

Ability to evaluate pharmacy methods, procedures, and services.

Ability to communicate effectively verbally, and in writing.

Ability to establish and maintain effective working relationships with others.

Ability to solve problems and make decisions based on available information.

Ability to execute projects and assignments timely and accurately within a fast-paced environment.

Ability to conduct investigations, coordinate investigative activities, and accurately document the result of an investigation.

Ability to conduct fact finding research.

Ability to work independently.

Ability to review and comprehend applicable federal and state laws, rules, policies, and regulations related to health care and enforcement activities.

Ability to formulate and implement pharmacy policies, methods, specifications and procedures.

Ability to provide training to team members.

Ability to plan, organize and coordinate work assignments.

Ability to monitor and coordinate clinical pharmacy services such as drug information, disease assessment, and medications management.

Ability to travel with or without accommodations.

MINIMUM QUALIFICATIONS REQUIREMENTS

Licensure as a Pharmacist in accordance with Florida Statute 465 and three years of professional experience in the practice of pharmacy as a licensed pharmacist.

A degree from a school or college of pharmacy accredited by an accrediting agency recognized and approved by the United States Office of Education.  A master's degree from an accredited college or university in pharmacy or a Pharm.D. from an accredited college or university can substitute for the required experience.

Preference will be given to candidates with a program integrity related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator; Certified Financial Crimes Investigator; Certified Insurance Fraud Investigator; or Certified Compliance and Ethics Professional.

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS

Licensure as a Pharmacist in accordance with Florida Statute 465.

CONTACT:    HELEN GUNN (850) 412-4626

BACKGROUND SCREENING:

It is the policy of the Florida Agency for Health Care Administration that any applicant being considered for employment must successfully complete a State and National criminal history check as a condition of employment before beginning employment, and, if applicable, also be screened in accordance with the requirements of Chapter 435, F.S., and Chapter 408, F.S.  No applicant may begin employment until the background screening results are received, reviewed for any disqualifying offenses, and approved by the Agency.  Background screening shall include, but not be limited to, fingerprinting for State and Federal criminal records checks through the Florida Department of Law Enforcement (FDLE) and Federal Bureau of Investigation (FBI) and may include local criminal history checks through local law enforcement agencies.

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS’ PREFERENCE.  Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply.  Certain service members may be eligible to receive waivers for postsecondary educational requirements.  Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code.  Veterans’ Preference documentation requirements are available by clicking here.  All documentation is due by the close of the vacancy announcement.