The Pharmacy Networks Manager is responsible for managing the Pharmacy Networks Department of the GEMS Medicine Management Provider Services (MMP). The Pharmacy Network Manager is responsible for implementing, maintaining, monitoring, and managing the GEMS pharmacy networks, referred to as the GEMS Medicine Provider Network (MPN) as well as the GEMS Courier Pharmacy to ensure that all Scheme requirements are met.
Duties and Responsibilities.
- Plan, organize, lead, and control the activities and staff of the Pharmacy Networks Department – GEMS MMP service.
- Responsible for the GEMS Medicine Provider Network (MPN) relationship.
- Ensure that the Scheme’s service level requirements as contained in the MMP contract are consistently met.
- Develop and/or maintain processes as well as associated systems to manage the pharmacy networks in accordance with the Scheme’s service level Network contract requirements.
- Ensure that the GEMS MPN database is established and maintained.
- Manage the GEMS Medicine Provider Network (MPN) application process and ensure that all applications meet the required criteria for enrolment on to the network.
- Ensure that all Network contracts received are legally valid and meet the required criteria.
- Ensure that the GEMS MPN pharmacies receive communication and education with regards their contractual obligations, operational deliverables, and Scheme requirements.
- Develop and define criteria for the profiling of the GEMS MPN pharmacies.
- Ensure proactive Provider relations (Strategic and operational meetings, sponsorship, and events).
- Ensure a strategic communication plan is compiled and communicated to the Scheme on a yearly basis.
- Proactive engagements with the Scheme and other SPN’s at the various forums/workstreams.
- Work with the actuaries to ensure that the profiling is accurate and implementable.
- Update the profiling criteria and minimum expected targets on an on-going basis based on Scheme expectations and/or requirements.
- Develop, produce, maintain, and distribute pharmacy-specific profiling reports.
- Monitor and manage compliance of GEMS MPN pharmacies against their contractual, regulatory, Scheme and operational requirements, including specific high-risk areas.
- Identify non-compliant GEMS MPN pharmacies and take steps to improve compliance.
- Take responsibility for ensuring compliance of the GEMS MPN pharmacies and for improving their level of compliance
- Develop and implement strategies and sanctions for non-compliance to performance expectations, contractual obligations, Scheme requirements, as well as Fraud, Waste and Abuse.
- Arrange meetings at least bi-annually with the GEMS MPN pharmacies including the GEMS Courier Pharmacy.
- Plan and organize GEMS MPN roadshow. The GEMS MPN meetings must take place in all regions of the country.
- Measure, monitor and manage the obligations and service delivery of the GEMS Courier Pharmacy.
- Ensure efficacious management of staff, as well as promoting development, with a view of ensuring overall SLA and client retention
- Identification and Mitigation of Risk, with the view of ensuring overall SLA and client retention
- Develop and produce Scheme reports in accordance with the Scheme’s Service Level Agreement.
- Develop and produce Management reports as required by the General Manager of MMP.
Reporting Lines
- The position will report directly to the General Manager: Medicine Management Provider (GEMS)
- The Relationship consultants, Administrators and Profiling and Compliance pharmacists will report to the Pharmacy Network Manager.
Experience and Qualifications Required
- Grade 12.
- A B. Pharmacist qualification.
- MBA or equivalent qualification will be advantageous.
- Experience in managing Provider Networks is an advantage.
- Minimum 4 years’ experience in the Medical Schemes Industry.
- Minimum 4 years’ experience in relationship management preferably in the pharmacy. environment or healthcare provider environment.
- At least 4 years’ managerial experience.
- An understanding of the legal and operational aspects of contracting is important.
Language Requirements
- Speaking and writing fluently in English
Computer Literacy
- Proficiency with the following programmes is required:
- MS Word
- MS Excel
- MS Outlook / email
- MS Explorer / Internet
- MS PowerPoint
Work Requirements
- The position will be based in Sunninghill Park, Sandton on a full-time basis
- Confidentiality of all patient’s clinical information and conditions to be maintained and respected.
- Company as well as Scheme intellectual property and systems may not be disclosed to external agents or organisations.
- Own transport (valid driver’s license) is essential.
- Travel will be required for the purpose of meeting pharmacies, clients, stakeholders, as well as for off-site personnel/management engagements.
- Willingness to work long hours when required is a requirement.
Remuneration
A competitive salary and benefits will be negotiated, consistent with experience and the role and responsibilities of the position.
The Employment Equity approach of Universal Healthcare broadly aims to:
- Foster diversity in the workplace;
- Promote equal opportunity and fair treatment in employment through the elimination of all forms of unfair discrimination.
Thank you for your interest in working for Universal Healthcare. Kindly note that your application will be reviewed in accordance to the job requirements and the Company will select suitable candidates with cognisance of its Employment Equity policy. Should no response be received within 30 working days from your date of submission, please consider your application unsuccessful for this position, your resume will remain active in our database should you be suitable for positions in future.
Desired Skills:
- Strong numerical and analytical skills
- Attending and presenting at external engagements with the client and other providers
- Collaborate with departments to implement quality improvement processes to initiate or maintain compliance
- Excellent report writing skills are essential
- Strong verbal and written communication skills
- Problem solving skills
- Good organizational ability
- Ability to meet tight deadlines
Employer & Job Benefits:
- Medical Aid
- GAP Cover
- Retirement Fund
- Funeral Cover
- Group Life and Permanent Health Insurance
- 360 Degrees Loyalty Programme