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Senior Specialist, Pharmaceutical Benefits Management

3.00 to 4.00 Years   Doha, Qatar   04 Feb, 2022
Confidential Company
1 Jobs Openings
Job LocationDoha, Qatar
EducationBachelors degree / higher diploma
SalaryNot Mentioned
IndustryPublic Administration; Pharmaceutical Manufacturing; Pharmacies
Functional AreaNot Mentioned

Job Description

The job holder shall be responsible to have an in-depth and expert knowledge of pharmaceutical benefits management - preferably with previous experience at a national regulatory level with a demonstrated record of success. The job holder shall require to work with members of the teams within different departments to oversee all the pharmaceutical benefits provided. The job holder shall require to work in a highly challenging environment and demonstrate an ability to advise on policy, compliance and benefits matters.Key Role & Responsibilities

  1. Creating guidelines on pharmaceutical coverage as per international standards and insurance norms.
  2. Advising on pharmaceutical products to be included or excluded from the Basic Benefit Package mandated by the Scheme, using standardized approved inclusion-exclusion criteria.
  3. Studying the impact from financial and medical perspective of the pharmaceutical products that included or excluded in the Scheme.
  4. Assessing applications of Pharmacies who wish to operate within the Scheme and ensure applicants meet the standards required to safely operate within the Scheme.
  5. The job holder shall liaise with other departments and any other regulators and maintain relationship with healthcare providers in the network of the scheme and insurers for better delivery of pharmaceutical services.
  6. Responding to query and concerns from provider/pharmacies, members and any internal or external stakeholders.
  7. Maintaining pharmaceutical database, which should be updated on regular basis as per the guidelines of the respective regulators.
  8. Providing customer support and education to the members on the guidelines and criteria for utilization of the pharmaceutical benefits including covered and excluded products, prior authorization, copayments and PBM in general.
  9. Creating adjudication guidelines and process for a certain medicines
  10. Tracking the updates on the formulary drug lists for new and existing products
  11. Keeping pace with the changes and modifications introduced to the local, regional and international agreements and legislations, and studying their effect on the MHIS.
  12. Perform other related duties to meet the ongoing organizational needs.

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