Pharmaceutical benefit management or Case Management experience essential for this position.

EE Position

Salary: R 320k - R340k ctc per month (depending on experience and qualifications)

Minimum Requirements:

BCur degree
Minimum 5-6 years experience in the Medical schemes industry and managed healthcare as a Case Manager or Pharmaceutical Benefit Management role
Knowledgeable professional with a sound knowledge of the Medical Schemes Act, P legislation, ICD-10 and CPT coding

Job Purpose:

Administration of the review and assessing of PMB requests and CDL treatment plans. Evaluation and finalization of referred PMB applications in conjunction with the Clinical supervisor and/medical advisor. Ensure compliance to Scheme rules and PMB legislation.