Manager, Pharmacy Audit and Program Integrity

Pay: $95,000.00 - $125,000.00 per year
Job description:
Job Purpose
Ventegra is a fast paced, innovative virtual company. The Manager of Pharmacy Audit and Program Integrity manages the enterprise-wide pharmacy audit strategy, overseeing development, execution, and continuous improvement of audit and program integrity initiatives across the company.
Duties and Responsibilities
·Define and lead the enterprise-wide pharmacy audit and program integrity strategy, including audit portfolio prioritization, scalable governance frameworks, operating models, workflows, standardized documentation, execution oversight, and achievement of quality, compliance, timeliness, and financial recovery objectives.
Serve as the liaison for external pharmacy audit partners, establishing strategic oversight of vendor performance, enforcing accountability for deliverables, and ensuring alignment with internal stakeholders and organizational priorities.
Lead risk-based audit monitoring and continuous improvement efforts by leveraging claims data, audit outcomes, and external indicators to identify high-risk areas, direct root cause analysis company-wide, and implement corrective and preventive actions that address systemic issues and strengthen upstream business processes.
Deliver executive-level reporting and insights on program performance, trends, risks, financial impacts, and strategic recommendations while partnering with stakeholders to align audit strategies with enterprise priorities and risk mitigation goals.
Ensure audit programs are designed, governed, documented, and reported in compliance with all applicable state, federal, regulatory, and contractual obligations, including required submissions, reporting, audit readiness, and timely responses to regulatory inquiries.
Build and lead a high-performing audit function, including defining team structure, roles, and performance expectations, while fostering strong cross-functional collaboration across the organization
Required Skills and Abilities
Advanced knowledge of PBM operations, pharmacy claims processing, reimbursement models, and provider network dynamics
Strong leadership and organizational skills, with demonstrated ability to build and scale programs and teams
Ability to influence and collaborate effectively across all levels of the organization, including senior leadership and external partners
Strong analytical and problem-solving skills with the ability to translate complex data into actionable insights
Excellent communication and presentation skills, including experience delivering executive-level reporting
Experience working with large healthcare datasets and identifying patterns indicative of fraud, waste, abuse, or operational issues
Ability to translate business requirements into technical solutions in partnership with analytics and IT teams
Education and Experience
Doctor of Pharmacy (PharmD) preferred
7+ years of experience in PBM, pharmacy operations, audit, compliance, or program integrity
Demonstrated experience leading programs, initiatives, and cross-functional teams
Experience developing and overseeing pharmacy or PBM audit programs strongly preferred
Deep understanding of state and federal regulations related to pharmacy audit programs and FWA compliance
Proficiency in Microsoft Office tools and experience working with data systems (SQL, Access, or similar platforms preferred)
Travel Requirements
Must be willing to travel to team meetings and in person pharmacy audits as needed.
Work environment requirements
A home office setting, free from noise and distraction allowing you to interact professionally both externally and internally
Benefits:
401(k)
401(k) matching
AD&D insurance
Dental insurance
Employee assistance program
Health insurance
Health savings account
Life insurance
Paid time off
Prescription drug insurance
Retirement plan
Vision insurance
Wellness program
Experience:
pharmacy claim audit: 2 years (Required)
pharmacy: 2 years (Required)
PBM: 2 years (Required)
management: 2 years (Required)

Work arrangement
Yes