Aridell Associates, LLC

​Serving tHE Healthcare,

Financial, Insurance, and Public SectorS

Current Job Opportunities

​Job Title: Pharmacist Specialist (Contract Position)
Post Date: 6/10/2025 – 7/1/2025

About Us
Aridell Associates, LLC, a professional consulting firm, advises clients on healthcare program operations and helps clients develop solutions to maximize meaningful outcomes, improve their operations, and protect their valuable assets, as well as bestow customer confidence in their operations.  Our mission is to advance clients’ operational performance and provide sustainable long-term, successful business strategies.

Position Summary
If you are interested in providing consulting and advisory services or supporting contracts, then this operational support position is for you.  The Pharmacist Specialist is well-versed in healthcare supply chain, drug utilization management, formulary management, and possesses the skills to assess healthcare services to ensure each one is medically necessary, appropriate, effective, efficient, while also understanding government insurance program guidelines and cost-containment strategies. The Pharmacist Specialist serves as an integral member of a multi-disciplinary team in supporting audits focused on health plans for a client. In this position, you will work collaboratively with other professionals; conduct research; collaborate on developing audit and analytical approaches, methodologies, and strategies; perform fieldwork; and report results. The Pharmacist Specialist will receive all directions and instructions from a program manager or their designee for the work activities under a contract.  

Responsibilities

• Provide pharmaceutical subject matter expertise (e.g., formulary, drug interactions, pharmacy benefits management, medication therapy management, drug utilization management, etc.) on healthcare policies, programs, regulations, laws, products, services, and billing and payment methodologies in support of audits. 
• Assess compliance with government laws and regulations.
  
• Gather and organize information about a problem to be solved or the procedure or process to be improved.
  
• Analyze financial, operational, and performance data, information, and other forms of evidence.
  
• Participate in on-site and off-site audit activities.
  
• Interact and confer with team members on a variety of topics, such as ideas, projects, approaches, methodologies, and strategies, using all forms of available communications.
  
• Identify and aid in the development of best practices for conducting audits.
  
• Review and analyze encounter data, fee-for-service claims, enrollment data, prescription drug event records, and other data sources in providing advice, input, and recommendations.
  
• Interpret Medicare policies, laws, rules, regulations, manuals, and healthcare industry guidelines in conducting audits.​
  
• Educate and explain prescription drug benefit management practices to clients and team members as needed.
  
• Serve as a technical resource in drug plan operations and data.
  
• Mentor, educate, and train other audit and analytical personnel, as well as partners and stakeholders. 
  

Qualifications

• The pharmacist shall possess a PharmD degree, from an Accreditation Council for Pharmacy Education (ACPE) accredited institution. The pharmacist shall maintain a valid license to practice in at least one state within the United States.
  
• The nature of the work requires a minimum of 10 years of experience supporting government, compliance, and program integrity operations. Experience working for a health plan, regulatory government agency, special investigation unit, and program integrity contractor is preferred.
  
• Must possess substantial familiarity with federal healthcare programs, such as Medicare Advantage Organizations, Medicare Prescription Drug Plans, and the Program of All-Inclusive Care for the Elderly (PACE), and the governing laws, rules, regulations, and policies. Preference is given to candidates with outstanding organizational, time management, and interpersonal skills; superior technical writing and research ability; and a demonstrated commitment to professionalism and ethics.
  
• The role requires one with a familiarity with managed care audits.
  

 
Knowledge and Skills

• Must have a strong foundation in the drug supply chain and an understanding of the medical aspects of patient care and treatment plans.
  
• Extensive knowledge of Medicare Part D prescription drug benefits.
  
• Strong experience in reviewing medical records to assess claims and encounter data.
  
• Knowledge of prior authorizations, coverage determinations, appeals, and grievances and the associated operations and regulations.
  
• Knowledge of formulary management practices and internal controls to ensure the proper utilization of benefits.
  
• Experience with assessing medical necessity based on evidenced-based clinical standards.
  
• Knowledge of healthcare systems, including insurance reimbursement guidelines and regulations.
  
• Ability to analyze data and reports to identify trends and areas for improvement in healthcare settings.
  
• Knowledge of NDC, CPT, DRG, HCPCS, ICD-9, and ICD-10 codes. 
  
• Strong organizational planning and prioritization skills with the ability to collaborate with others and multi-task.
  
• Excellent written and verbal communication skills.
  
• Ability to present to large or small groups when required.
  
• Proficient in using the Microsoft Office Professional Suite, including Word, Excel, PowerPoint, and Outlook.
  

Travel Requirements
Occasional travel to audit sites is required. Travel is reimbursable.

Job Location
This is a work-from-home/remote position.

Apply Now
Email a cover letter and resume To: jarias@aridell.com​​​