Reference: DBN003550-RC-1 A prominent Medical Scheme Company is seeking a Specialist in Pharmaceutical Benefit Management. The Company is an accredited managed healthcare organisation that services clients in the medical scheme industry. They are privileged to have one of the largest growing medical schemes in South Africa as a client and an opening exists for an experienced pharmacist assistant to join their Pharmacy team. The purspose of this role is 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. Responsibilities: 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 possible. Communicate DUR to prescriber / member / pharmacy. Identify and intervene on any drug interactions between disease conditions and medicine. 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 changes. 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 reimbursement. Managing CPAP and stoma requests and loading of authorisations. Prepare complex cases for clinical review for exceptional funding by the medical schemes. Follow up on weekly medicine claim rejections to ensure members are registered and have access to medication. 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 enroll in courses to broaden their knowledge on medicine and related conditions to optimally manage our clients. 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) Candidates that meet the criteria may submit their applications via this portal or via vacancy link on www.mnarecruitment.com Should you receive no feedback within 7 days, please accept your application as unsuccessful. Apply Now

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