About the position
A well-established company is recruiting for a
GENERAL MANAGER: PHARMACY NETWORKS MANAGEMENT PROVIDER
SUNNINGHILL
PURPOSE OF THE JOB
The General Manager - Pharmacy Networks Management Provider (PNMP), is responsible for leading the strategic and operational activities related to the pharmacy network. This role oversees the development, optimization, and performance management of pharmacy provider networks, ensuring compliance with regulatory standards, funding requirements, and member satisfaction goals.
RESPONSIBILITIES & DUTIES:
Operations
- Ensure that unit consistently meets the Scheme's service level requirements
- and operational deadlines.
- Ensure that The PNMP unit is patient-centric and supports the Scheme's
- strategic objectives.
- Define, establish and refine workflow processes throughout The PNMP to meet the required deliverables and achieve maximum efficiencies.
- Manage the PNMP business unit to ensure that productivity targets and quality standards are consistently met.
- Recruit and appoint new staff in line with the existing recruitment policy.
- Ensure that standard operating procedures are compiled, implemented and maintained for each functional area.
- Ensure that quality control processes are maintained, refined and consistently applied.
- Ensure that staff are fully trained and regularly assessed.
- Plan staffing and ensure that resources are appropriately deployed to meet varying operational requirements.
- Define, establish and refine day-to-day operational measurables.
- Ensure the timeous compilation and submission of Scheme required reports.
- Ensure the timeous compilation and distribution of business management reports.
- Ensure Scheme service provider integration and the management of service provider networks (SPN) relationships.
Network Strategy & Development:
- Develop and implement strategies for building and maintaining a high- performing pharmacy provider network.
- Lead contract negotiations and ongoing relationships with pharmacies, including chains, independents, and specialty providers.
- Ensure that the geographic coverage and accessibility of the GEMS pharmacy network aligns with regulatory requirements and business goals.
Performance Management & Analytics
- Analyse network performance using KPIs (e.g., cost, utilization, access, quality).
- Identify underperforming pharmacies and develop corrective action plans.
- Lead initiatives to improve adherence, medication therapy management (MTM), and clinical outcomes.
Stakeholder Engagement
- Ensures a good relationship with pharmacy providers, the clearing house, internal departments, the Scheme's other service provider networks (SPN's)
- Maintain strong relationships with internal and external stakeholders to support value-based care and population health initiatives.
Regulatory Compliance
- Ensure the pharmacy network complies with all statutory regulations
- Support audits and provide necessary documentation and reporting.
Operational Oversight
- Oversee day-to-day operations of pharmacy network management, including credentialing, contract management, and performance monitoring.
- Drive process improvement initiatives to increase efficiency, reduce cost, and improve quality of care.
- Manage pharmacy claims operations in partnership with the PBM and IT departments.
Team Leadership
- Lead, mentor, and develop a team of operations managers and support staff.
- Foster a culture of accountability, innovation, and continuous improvement.
- Leadership and Business Continuity Strategy
Reporting lines
- The position will report directly to the Managing Director: Universal Care
- This position will receive direct reports from the following persons and business units:
- Inbound Call Centre manager,
- Outbound Call Centre manager,
- Fund Manager,
- Pharmacy Network Manager,
- Quality Assurance Manager and
- Training Manager report to this position.
QUALIFICATION & EXPERIENCE
- A Pharmacist qualification (B. Pharm/M.Pharm)
- Minimum 5 year's senior management experience within the medical scheme industry is preferred
- An additional qualification, preferably business/strategy will be advantageous
- Preference will be given to previously disadvantaged candidates
- Understanding of the Community Pharmacy environment
- Understanding of medicine supply
- Understanding of Pharmacoeconomics
- Experience in and understanding of medicine utilisation and costs in a medical scheme, and analyses pertaining thereto
Desired Skills:
- pharmacist
- networks management
