Supervisor: Clinical Risk (Bryanston)

A Medical Aid company based in Bryanston needs to appoint a Clinical Risk Supervisor with DUR and Prescribed Minimum Benefit knowledge.

Education, Qualifications and Experience:
•B Pharm, Registered with the SAPC
•Previous supervisory experience advantageous
•M Pharm an advantage
•Previous experience in a managed healthcare environment essential
•Computer literate in Windows packages essential especially Microsoft word and excel
Knowledge & skills:
•Knowledge of DUR and Prescribed Minimum benefit protocols essential
•Risk Equalization Fund knowledge an advantage
Duties:
Duties may include, but are not necessarily limited to:
•Telephonic authorisation of chronic medication according to Scheme specific protocols
•Authorisation of chronic medication according to Prescribed Minimum benefit protocols
•Retrospective review of chronic medication claims
•Developing and maintaining clinical protocols including new drug reviews
•Working with other healthcare personnel within the organisation
•Liaising with outsourced providers and suppliers
•Assisting doctors and pharmacists with telephonic queries and on-line prescriptions. Giving feedback on protocols (Prescribed Minimum Benefits) and DUR changes (DUR: Generic Substitution, Therapeutic substitution, Efficacy and Drug Interactions)
•Manage ad hoc clinical projects as required
•Compilation of the REF reports
•Review and update clinical protocols and guidelines
•Provide clinical expertise within the organization where required
•Provide clinical support and guidance for disease management programmes.
•Assist in the conceptualization, planning and implementation of new managed care products
•Daily feedback to staff on targets achieved
•Work as a team with other supervisors to ensure cohesiveness in strategy of call centre
•Schedule the weekly roster
•Ensure good communication between various department, accessing information and alerting to problems
•Escalate departmental issues to manager
•Responsible for leave/ absenteeism register
•Assist with identifying and meeting training needs
•Assist by providing information of call quality and written quality
•Research and preparation for KPA’s
•Responsible for maintaining departmental stats
•Assist with all HR issues i.e. performance counselling
•Conduct telephonic assessment, competency assessments and 1st line interviews during recruitment
•Deal with escalated queries in partnership with consultant who escalated query
•Take on a coaching role for new staff starting on the phones
•Continually maintain ISO documentation
•Monitor workload to ensure SLA met