Talent Pool: Pharmacist Assistant MMH251114-10

Momentum Centurion, Gauteng, South Africa Role Purpose Complete the registration of Chronic conditions and treatments and to give support to the DUR Pharmacists. Requirements Matric - essential Pharmacist Assistant Basic - essential Post Basic Pharmacist Assistant Qualification or Pharmacy Technician Certificate - desirable Registration with the Pharmacy Council as Pharmacist Assistant - essential Member of the PSSA - desirable Minimum of 2-3 years working experience in a retail pharmacy or private hospital setting as a Post Basic Pharmacist Assistant. Experience in processing a prescription and dispensing medicine under the supervision of a pharmacist. Experience with interacting with members, pharmacists, and/or doctors in a confident and courteous manner in person and/or telephonically. Experience in analyzing medical history, medicines, and patients' lifestyles. Previous experience interacting with and counselling/guiding patients/members with regard to their medicine and diagnosis in a pharmacy setting. Previous chronic management and DUR experience would be an advantage. Previous experience in a managed care environment would be an advantage. Previous experience in a call centre environment would be an advantage. Clinical knowledge on medicine trade/ and the names and the usage of the original and generics/clones. Knowledge of medication classes and indications. Knowledge of ICD10 codes. Knowledge of The South African Pharmacy Law and good practices. Knowledge of physiology and basic disease conditions. Knowledge of drug indications and interactions. Knowledge of pharmacy practice, requirements of a valid prescription, valid prescriber, valid dispensing practice and record keeping. Understanding medical aid industry, relevant policy and clinical guidelines. Knowledge of diseases, management of disease lifestyle and general. Knowledge on how to use and navigate on a computer system. Duties and Responsibilities Manage medication benefits to ensure the most cost-effective treatment is funded for optimal treatment outcomes. Real-time provideinteraction and decision-making are essential to provide customer satisfaction whilst still keeping in line with clinical policies and scheme rules. Registration of treatment for chronic conditions according to guidelines and clinical entry criteria timeously and independently to ensure access to treatment. Authorize or decline medicine/diagnosis in line with scheme rules, mandates, and MHS clinical policies to assist in keeping the scheme financially viable whilst at the same time improving the patient's health. Consistently maintaining a 24-hour turnaround time from receipt of documents/calls into the correspondence workflow bin. Ensure effective claims management troubleshooting and support. Escalate any queries which cannot be handled to the DUR Pharmacists or manager for the patient or provider to get timely feedback. Identify all compliance risks to protocols and procedures. Identify and investigate all possible non-disclosure of pre-existing conditions for new members joining the scheme. Participates in the creation and maintenance of clinical guidelines to guide authorisation. Ensure the consistent and correct application of drug exclusions to prevent funding. Engage in effective communication and delivery according to Service Level Agreement. Provide professional first-time resolution on queries to ensure the best treatment outcome. Monitor customer delivery constraints are human or IT related and elevate these to management. Registration of chronic conditions is done timeously and independently if need be. Be involved in Oncology, maternity authorization requests, and claims reviews and escalations as part of the one-stop authorization centre going forward. Must handle members and providers professionally to drive Patient Advocacy with clients/members that support the business Retention and Growth targets. Manage the risk profile of scheme members, and decrease disease progression of the unwell. Perform an efficient and accurate administrative function by capturing authorization details and notes for history and disease recording. Identify and document compliance risks so that long‑term costs are decreased. Client To assist in improving the client experience with the team, Health Risk Management department, and Client Services. Provide expertise and advice to clients and internal stakeholders. Deliver on service level agreements made with clients and internal and external stakeholders to ensure that client expectations are managed. Make recommendations to improve client service and fair treatment of clients within the area of responsibility. Participate and contribute to a culture that builds rewarding relationships, facilitates feedback, and provides exceptional client service. Ensuring Patient advocacy by advising a member/provider of generics, alternatives, and DSP and assigning members to oneself to encourage lifestyle change, medicine, and treatment plan compliance. Must handle members and providers professionally to drive Patient Advocacy with clients/members that support the business Retention and Growth targets. Manage the risk profile of scheme members, and decrease disease progression of the unwell. People Ensure effective claims management service delivery and support to other teams and departments in the organisation. Develop and maintain productive and collaborative working relationships with peers and stakeholders (internal and external) and work as part of the team to provide effective service delivery. Positively influence and manage change and offer specialist support where required. Continuously develop own expertise in terms of professional, industry, and legislation knowledge and take ownership for driving career and/or personal development regularly. Contribute to continuous innovation through the development, sharing, and implementation of new ideas and involvement of colleagues and staff. Finance Contribute to the financial planning process within the area. Identify opportunities to enhance cost-effectiveness and increase operational efficiency. Manage financial and other company resources under your control with due respect. Provide input into the risk identification processes and communicate recommendations in the appropriate forum. Seniority level: Mid‑Senior level Employment type: Full‑time Job function: Health Care Provider #J-18808-Ljbffr