Pharmacist

7 days ago

Eastern Cape, South Africa Health Solutions Full time

**Introduction**
- Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of health capabilities.**Disclaimer**
- As an applicant, please verify the legitimacy of this job advert on our company career page.**Role Purpose**
- To manage medication benefits by adhering to the schemes’ respective rules and guidelines, resulting in the best outcome for both the member and scheme.**Requirements**:

- National Senior Certificate
- Bachelor of Pharmacy degree
- Valid registration with the South African Pharmacy Council (SAPC)
- Completed community service and internship
- Previous experience in a managed healthcare environment is advantageous
- Knowledge of the drug utilisation review process
- Experience in analysing pharmacy data is essential
- Knowledge of Prescribed Minimum Benefits is advantageous

**Duties & Responsibilities**
- Authorise Chronic Medication: Approve chronic medication prescriptions based on clinical protocols, treatment guidelines, and formulary adherence.
- Resolve Claims and Authorisation Queries: Provide expert assistance to doctors, pharmacists, and members on queries related to claims, pre-authorisations, and medication coverage.
- Conduct Drug Utilisation Reviews (DUR): Continuously monitor and evaluate the prescribing, dispensing, and usage of medications to ensure safe, effective, and appropriate therapeutic decision-making for optimal patient outcomes.
- Review Chronic Medication Claims: Perform retrospective reviews of chronic medication claims to ensure compliance with policies and appropriate usage.
- Maintain Drug Formularies: Evaluate new medications entering the market, compare pricing for generic and therapeutic alternatives, and manage drug exclusion reviews to keep formularies updated and cost-effective.
- Conduct Forensic Investigations: Investigate potential fraud, waste, or abuse related to medication claims and make recommendations based on findings.
- Oversee Reporting and Audits: Manage daily, weekly, monthly, and quarterly reporting processes.
- Collaborate with Healthcare Teams: Work closely with internal healthcare professionals, such as doctors and nurses, to ensure cohesive care management.
- Liaise with External Providers: Coordinate with outsourced providers, suppliers, and vendors to ensure seamless service delivery and cost-effective medication management.
- Manage Clinical Projects: Lead and oversee ad hoc clinical projects, providing strategic input and ensuring alignment with organisational goals.
- Review Clinical Protocols: Regularly evaluate and update clinical protocols and treatment guidelines to reflect best practices and evidence-based medicine. Ensure effective communication amongst all stakeholders.
- Provide clinical expertise within the organisation where required.
- Disease management case identification and provide clinical support and guidance for disease management programmes.
- Conduct Data Analysis to Address Key Issues: Utilise data analysis to identify trends, inefficiencies, and opportunities for improvement within the team’s operations, providing insights and actionable recommendations to resolve challenges and optimise processes.

**Competencies**
- Pharmaceutical knowledge and expertise
- Regulatory and compliance knowledge
- Excellent collaboration and communication skills, both verbal and written
- Data analysis and interpreting
- Decision making skills
- Following procedures
- Operational and project management

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