GEMS Jobs in Gauteng – Management Specialist

Website Government Employees Medical Scheme - GEMS

Job Description:

There is currently a Specialist: Medicine Benefits Management vacancy. The Specialist: Medicine Benefits Management role will report directly to the Senior Manager: Clinical Risk Management, and forms part of the Healthcare Management division. The position is permanent and will be based at GEMS Head Office.

Job Responsibilities:

  • the Courier Pharmacies and the Pharmacy Benefit Management Services Provider;
  • Oversee the implementation of operational risk mitigation strategies related to the adjudication and payment of pharmaceutical benefits.
  • Management of the interface and inter SPN processes between:
  • Management of the utilisation, adjudication and payment of Medicine benefits as per Scheme rules.
  • Management of the technical aspects of the Courier Pharmacy Service Providers and Chronic Medicine benefits provided through the Courier Pharmacies.
  • Draft member communication to support the correct and optimal utilisation of the medicine benefits.
  • Attend various Forums and make valuable contributions by providing expertise needed to ensure sound management of medicine management services.
  • Implementation of the regulatory compliance measures in relation to the adjudication and payment of Pharmaceutical Benefits.
  • the Pharmacy Benefit Management Services Provider and the Administrator; and o the Pharmacy network manager and the Courier Pharmacies.

Job Requirements:

  • Ability to work well as part of a team.
  • Analytical with excellent written and verbal communication.
  • Minimum 3-year Diploma/Degree in Medical/Clinical Sciences (B Pharm qualification advantageous).
  • Must be in possession of a valid driver’s license and own vehicle and be willing to travel at short notice.
  • Minimum 5 years’ work experience in the healthcare funding/medical scheme industry including two years at management / supervisory level.
  • Solid Medicine Benefits Operations experience and Medical Schemes operational insight

Job Details:

Company: Government Employees Medical Scheme – GEMS

Vacancy Type:  Full Time

Job Location: Pretoria, Gauteng, SA

Application Deadline: N/A

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