SPECIALIST - PBM at MEDICAL SCHEME

About the position

An accredited managed healthcare organisation that service clients in the medical scheme industry. We are privileged to have one of the growing medical schemes in South Africa as a client and an opening exists for an experienced pharmacist assistant to join our Pharmacy team.

Purpose of the position

To perform drug utilisation review and actively manage and coordinate the approval of a member's 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.

• Perform drug utilization review (DUR) on all new and/ or changed in chronic and acute prescriptions in accordance with the relevant medicine formulary.
• Lower healthcare costs through DUR interventions where
• Communicate DUR to prescriber / member /
• Identify and intervene on any drug interactions between disease conditions and
• Assist with treatment counselling and disease management interventions for members who are registered on the HIV active disease risk management programme.
• Resolve any medicine price queries with the relevant clearing houses/ pharmacy benefit manager (PBM).
• Inform clearing houses (PBM) of prescription
• Follow up on additional information requested from clearing houses to complete members chronic registration and medicine authorization.
• Be able to assist the medical scheme with paper claim pricing for member
• Managing CPAP and stoma requests and loading of
• Prepare complex cases for clinical review for exceptional funding by the medical
• Follow up on weekly medicine claim rejections to ensure members are registered and have access to medication
• Medical scheme medicine claim submission, reversals and queries experience is essential

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)

• PLEASE NOTE: EXPERIENCE IN MANAGED HEALTHCARE IS ESSENTIAL

Desired Skills:

• MANAGED HEALTHCARE
• POST BASIC PHARMACIST ASSISTANT QUALIFICATION
• STRONG KNOWLEDGE OF PMB
• KNOWLEDGE OF MEDICINE CLAIMS