
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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