Specialist Pharmaceutical Benefit Management

About the position

A well-established company is recruiting for a
SPECIALIST: PHARMACEUTICAL BENEFIT MANAGEMENT
12 MONTH CONTRACT
PRETORIA

PURPOSE OF THE JOB
To perform drug utilisation review and actively manage and coordinate the approval of a member's chronic medicine and to ensure that the incumbent 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.

DUTIES AND RESPONSIBILITIES, AMONGST OTHERS INCLUDE:

• 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 house (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 or 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 ar registered and have access to medication

QUALIFICATION & EXPERIENCE

• Registered qualified Pharmacist Assistant (Post Basic)
• Valid registration with SAPC (paid up to date)
• 3 years' managed healthcare experience is essential
• Excellent working 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
• May be required to periodically work overtime to achieve required workflow output

Please send your cv and supporting documents to [Email Address Removed].
If you have not received any feedback within 2 weeks please assume that your application was not successful

Desired Skills:

• pharmacy
• dur
• benefit management