Job Description
Job Ref. No: JHIL093
Position: Assistant Manager – Pharmacy Benefits Management
Terms: Permanent
Jubilee Insurance was established in August 1937, as the first locally incorporated Insurance Company based in Mombasa. Jubilee
Insurance has spread its sphere of influence throughout the region to become the largest Composite insurer in East Africa, handling
Life, Pensions, General andMedical Insurance. Today, Jubileeis the number oneinsurer inEastAfricawithover 450,000clients. Jubilee
Insurance has a network of offices in Kenya, Uganda, Tanzania, Burundi, and Mauritius. It is the only ISO certified insurance group
listed on the three East Africa stock exchanges – The Nairobi Securities Exchange (NSE), Dar es Salaam Stock Exchange and Uganda
Securities Exchange. Its regional offices are highly rated on leadership, quality and risk management and have been awarded an AAin Kenya and Uganda, and an A+ in Tanzania. For more information, visit www.JubileeInsurance.com.
We currently have an exciting career opportunity for an Assistant Manager – Pharmacy Benefits Management within
Jubilee Health Insurance Limited. The position holder will report to the Manager – Strategic Purchasing and Provider
Partnerships and will be based at our Head Office in Nairobi.
Role Purpose
To supervise and provide guidance on all matters relating to pharmaceutical cost control and pharmacy benefits management.
Main Responsibilities
1. Analytics – conduct regular analysis on claims patterns from providers to ensure proper adjudication within the stipulated policy
terms. Conduct trending analysis; identify leakage; and prepare objective reports on claims and case processing processes.
2. Develop and implement strategies for decreasing the company pharmaceutical expenditure.
3. Pricelist Management – Monitor and evaluate prices to ensure provider adherence to the reasonable and customary rates and
undertaking recovery measures where necessary.
4. Developing quality control processes. Provide technical support to claims processing teams i.e., reimbursement team, quality
assurance team, care managers and contact center representatives on clinical queries to ensure guided verdicts.
5. Achieving medical quality assurance operational objectives by contributing information and analysis to claims strategic plans and
reviews. Identifying problems, completing audits, determining system improvements, and implementing change.
6. Training of relevant teams on pharmaceuticals or current treatment protocols where it is identified that there is a knowledge gap.
7. Prepare pharmacy quality assurance documentation, presentations & reports. Analyzing and summarizing trends including failed
processes, fraudulent activities, registered claims errors, corrective actions and re-validations on a weekly, monthly, quarterly,
and yearly basis or as required by the business.
8. Preauthorization of prescription drugs under stipulated parameters.
9. Generic substitution – Advocate the use of generics where necessary as a method of reducing the co pharmaceutical expenditure
targeting a reverse ratio.
10. Poly-pharmacy – Enforce standard treatment guidelines in refence to the indicated diagnosis Discourage polypharmacy by diligently
challenging of prescriptions and suggesting suitable alternatives.
11. Provide technical support to claims adjudication teams i.e., reimbursement team, quality assurance team, care managers and
contact center representatives on clinical queries to ensure guided verdicts.
12. Drug Utilization Review – Advising clients and providers where adverse drug reactions are suspected or where potential of drug
interactions exist and checking dosage and ensuring that medicines are correctly prescribed.
13. Keeping up to date with the latest clinical guidelines for common ailments including non-communicable diseases as provided by
Ministry of Health and other internationally recognized clinical bodies.
14. Participate in formulation of appropriate CPT codes for medicines to track expenditure.
15. Maintains pharmacological knowledge by attending educational workshops; reviewing professional publications; establishing
personal networks; participating in professional societies.
16. Maintaining knowledge of new developments in the pharmaceutical sector, anticipating potential negative and positive impacts on
the business, and adapting strategy accordingly.
17. Performs other related duties as assigned, which may be inclusive, but not listed in the job description.
18. Form and foster strategic partnerships with relevant stakeholders to improve quality outcomes and cost-effective pharmaceutical care.
Key Competencies
1. Strategic thinking
2. Analytical
3. Creativity and innovation
4. Negotiation
5. Excellent analytical skills
6. Performance reporting and management
7. Training supervision and leadership
Qualifications
1. Bachelor’s degree in pharmacy or equivalent.
2. Registration with the relevant professional body.
3. Basic understanding of the concepts of insurance
4. Proficient in the use of Microsoft office suite and packages.
Relevant Experience
1. At least two years in Clinical Practice.
2. 5 years’ Relevant experience in Pharmacy Benefit Management.