Specialist Pharmaceutical Benefit Manager

Quality Select Recruitment

Pretoria, Gauteng
Contract
Full-time

14 days ago

Our client, a managed care organisation based in Pretoria is looking for a Specialist Pharmaceutical Benefit Management to join their pharmacy team. This is an equal opportunity organisation with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries.Reporting to: Senior Specialist: Pharmaceutical Benefit ManagementLocation: On-site at the Head Office, PretoriaContract Type: Fixed-term Contract for period of 12 months (With the possibility of becoming permanent).Salary: Subject to experience, market related Cost to Company (includes benefits such as medical aid, pension fund etc)Purpose of the position:To perform drug utilisation review and actively manage and coordinate the approval of a members chronic medicine and to ensure that he/ she has access to this treatment within the available scheme benefit and medicine formulary. To participate in the clinical review of existing treatment and, where appropriate, assist with motivation for exceptional funding for non-formulary medicines and to engage with various stakeholders both internal and external.Qualifications:

Registered Qualified Pharmacist Assistant (Post Basic)
(Basic pharmacist assistant will not be considered for the position)
Valid registration with SAPC (paid up to date)

Skills and Competencies Required:

Minimum 3 years managed healthcare experience is essential.
Excellent knowledge of all 27 CDL conditions, including HIV medicine and treatment regimes.
Good knowledge of medicines to treat the 27 chronic disease list (CDL) conditions and clinical criteria requirements for
each condition.
Computer literate MS Office product suite, Outlook, Word, Excel, and pharmacy dispensing software systems.
Attention to detail is crucial.
Demonstrate excellent customer-service and organisational skills.
Strong telephonic and written communication skills (be able to manage difficult clients telephonically in a professional and
calm manor).
Proficiency in English (speak and write will be tested).
Additional languages (speak) will be an advantage Sesotho, Setswana, isiXhosa, isiZulu.
Competency in medical scheme medicine claim submissions, reversals, queries.
Be able to understand claim rejections and how to resolve them.
Handling complex queries effectively.
Problem identification and resolution.
Leadership skills, work independently and showing initiative.
Analytical and critical-thinking skills.
Strong reporting skills.
Ability to work well with others.
Ability to relate to people.
Excellent communicator with ability to influence others.
Basic business math skills and knowledge of mathematical/statistical concepts.
Ability to maintain confidential and/ or sensitive information.
Patient and a calm manner.
High stress tolerance.
Following through on commitments.
Results orientation.
Willing to enrol in courses to broaden their knowledge on medicine and related conditions to optimally manage our clients

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