There is currently a Specialist: Medicine Benefits Management vacancy. The Specialist: Medicine Benefits Management role will report directly to the Senior Manager: Clinical Risk Management, and forms part of the Healthcare Management division. The position is permanent and will be based at GEMS Head Office. 
 
The total remuneration package for this position is negotiable based on qualifications and experience. 
 
The Specialist: Medicine Management will be required to provide support to the Senior Manager: Clinical Risk Management through the implementation of the following Key Performance Areas (KPAs):

• Management of the utilisation, adjudication and payment of Medicine benefits as per Scheme rules

• Implementation of the regulatory compliance measures in relation to the adjudication and payment of Pharmaceutical Benefits

• Management of the technical aspects of the Courier Pharmacy Service Providers and Chronic Medicine benefits provided through the Courier Pharmacies

• Management of the interface and inter SPN processes between

  o the Courier Pharmacies and the Pharmacy Benefit Management   Services Provider

  o the Pharmacy Benefit Management   Services Provider and the Administrator

  o the Pharmacy network manager and the Courier Pharmacies

• Oversee the implementation of operational risk mitigation strategies related to the adjudication and payment of pharmaceutical benefits 

• Attend various Forums and make valuable contributions by providing expertise needed to ensure sound management of medicine management services’ 

• Draft member communication to support the correct and optimal utilisation of the medicine benefits 

 Qualification, skills and competencies requirements are:

• Minimum 3-year Diploma/Degree in Medical/Clinical Sciences (B Pharm qualification advantageous)   

• Minimum 5 years’ work experience in the healthcare funding/medical scheme industry including two years at management / supervisory level

• Solid Medicine Benefits Operations experience and Medical Schemes operational insight   • Analytical with excellent written and verbal communication 

• Ability to work well as part of a team

• Must be in possession of a valid driver’s license and own vehicle and be willing to travel at short notice 

All external candidates, please apply via Career Junction using the following link :

https://www.careerjunction.co.za/companies/35144/government-employees-medical-scheme


The closing date for applications is 22 August 2022. Should you not hear from us by 31 October 2022 please consider your application unsuccessful. 

*** GEMS employs people with the highest level of integrity – submission to the appropriate pre-employment assessment is obligatory to be considered for the position.

*** Information is required for Employment Equity purposes.

*** Kindly note that the information provided on application of the position may be shared with a third party for vetting purposes and will be stored by GEMS for a period of 5 years.

*** Should you wish to have your information removed from the GEMS database, kindly send a request in writing to jobs@gems.gov.za.

***Gems is guided by the principles of employment equity. Preference will be given to groups who are underrepresented in accordance with Gems employment equity plan.