Job Description
The job holder will be responsible for promoting the rational use of medicines and guiding implementation of strategic purchasing for pharmaceuticals to ensure consistent delivery of high-quality cost-effective care, optimum health outcomes and excellent patient experience.
KEY ROLES AND RESPONSIBILITIES
Promote rational use of medicines – advocate for rational prescribing and dispensing by adhering to standard treatment guidelines
Strategic purchasing for pharmaceuticals – develop and implement strategic purchasing initiatives for pharmaceuticals
Preventive care – facilitate integration of preventive and promotive services and provide input during product development and benefit design process
Member education – continuous education for members on appropriate use of medications, common side effects and drug prices
Polypharmacy – monitor for unnecessary polypharmacy for appropriate interventions including provider engagement and referral for Medication Therapy Management
Adherence counselling – monitor patient adherence to medications and counsel those who are non-adherent
Generic substitution – engage providers and members on the role of generic medications in improving health in a cost-effective way
Drug Formulary Management – provide input to provider’s formularies to ensure cost-effective use of medicines
Pharmacy pricelist management – monitoring of pharmacy prices to ensure adherence to Recommended Retail Prices
Pharmacy benefits management – oversee pharmacy preauthorization through timely and accurate adjudication of pharmacy preauthorization requests
Drug delivery – support disease management programs by linking members with chronic conditions with preferred pharmacies for drug delivery
Pharmacy analytics – analysis of prescription patterns for providers and prescription drug use by members and analyze morbidity data to recommend appropriate interventions
Monitoring errors in pharmacy claims adjudication and preauthorization to inform accuracy in claims management
Drug utilization review – advise clients and providers on potential adverse drug reactions or drug interactions and counterchecking prescriptions for correctness
Pharmacy technical support – provide technical support to the clinical team on queries revolving around prescription drugs.
Keep up to date with current clinical guidelines for common ailments (including NCDs) provided by Ministry of Health and other internationally recognized clinical bodies.
Pharmaceutical market intelligence – keeping abreast with new developments in the pharmaceutical sector, anticipating potential impacts on the business, and adapting strategy accordingly
Actively collaborate with specialists, general practitioners, pharmacists, hospitals, patients, and other relevant stakeholders in promoting rational use of medicines
SKILLS AND COMPETENCIES
Excellent communication, negotiation and interpersonal skills
Excellent analytical and monitoring skills
High level of integrity and honesty
Team player, commitment and ownership
Empathy and Customer Focus
QUALIFICATIONS, KNOWLEDGE & EXPERIENCE
Diploma in Pharmacy
At least 3 years’ experience in a busy private hospital or clinic setting
Prior experience in a health insurance company is highly desirable
Solid understanding of insurance principals
Strong data analytics capability
Apply via :
oldmutual.wd3.myworkdayjobs.com
