Wellness and Disease Manager (BPharm Qualification Required)

Position Description

Our client a nationally recognised leader in the field of medical scheme services requires a Wellness and Disease Manager for the Management of delivery of cost-effective managed healthcare service to accomplish member satisfaction and to deliver affordable managed healthcare services for members.(Care for cancer, HIV, dialysis, wellness, and preventative care)

You'll work as a trusted and integral team member reporting directly to the Executive Manager: Managed Healthcare.

The suitable candidate will be English and Afrikaans speaking, since the candidate will have to deal with queries about medicines and well as clinical treatment plans from members and doctors

Responsibilities:

Manage the staff in the MHC Department including workflow, performance management and HR administrative functions.
Provide pre-authorisation for oncology and other disease managed cases, specialist visits, MRI, CT scanning, step down facilities and home nursing.
Negotiating with the different suppliers for discount on a prosthesis in cases where prosthesis amount is above the members limit
Clinical proof for new members and or dependents, which are being monitored, should be received before pre-authorisations are given.
Accomplishing member satisfaction by delivering outstanding client services together with satisfactory productivity.
To maintain good relations with clients and personnel at all times. To ensure that Case Managers Department, Claims Department and Pre-Authorisation Department work well together in a team at all times.
In depth IT system knowledge, changes and enhancements when required.
Attending workshops on a regular basis to gain adequate/up-to-date knowledge in order to deliver a cost-effective oncology, other managed care services and to provide the necessary training to personnel.

Candidate Requirements

Experience:

Thorough, well-grounded clinical knowledge of Pre Authorisation of Oncology and Case Management of oncology cases in order to take cost-effective and appropriate decisions in evaluating treatment. (Previous medical scheme experience in a Disease Management Department is a prerequisite, particularly with regard to the evaluation of treatment plans, including proven knowledge of the compilation of medicine formularies and clinical guidelines)

Knowledge of the current SAOC and ICON treatment protocols
Knowledge of Chronic Diseases (especially the CDL conditions)
Knowledge of the current coding structures in the South African Healthcare Environment i.e. ICD10’s is a prerequisite particularly in regards to protocols and algorithms

Qualifications:

B Pharm
Enrolled Pharmacist
3-5+ years’ experience as Pharmacist plus
1+ years’ experience gained in the medical funding industry
Medical Scheme – related experience in Cancer/Oncology

Salary:

R480 000 - R500 000 Per Year ctc
Benefits: medical aid and provident fund
Bonus: Performance based bonus