Care Management Officer 1

Job Purpose:

The jobholder is responsible for performing care management activities with minimal supervision including monitoring, inspection, and enablement of medical providers to ensure compliance with guidelines and standards.

Responsibilities:

• Execute work as per superior directions and work instructions
• Execute all activities, approaches, and tools under minimal supervisions
• Coordinate and communicate proactively with internal stakeholders
• Collect data and perform data entry
• Update on a continuous basis the database for tracking and reporting
• Escalate complex problems to ensure case/issue is closed efficiently and in a timely manner
• Assist team members and provide input to ensure projects and tasks are completed on time
• Perform other activities as and when required
• Prepare the evaluation report for the drugs to be added to the Unified Drug Formulary (UDF), including assessment of the economic impact.
• Conducting field research and detailed comparative studies in accordance with data quality guidelines for analysis
• Evaluating and maintaining the Daman Drug Formulary (DDF) based on clinical requirements and compliance with regulatory bodies and approvals from the Pharmacy and Therapeutics Committee (PTC)
• Serving as a member of one of the committees related to the Unified Drug Formulary (UDF)
• Communicating and receiving requests for additions to the Unified Drug Formulary (UDF)and updating requests and files from the drug manufacturers
• Archiving received requests
• Ensuring the accuracy of information and management standards for the use of the UDF
• Addressing inquiries related to the UDF
• Understanding the management standards for the use of the UDF, including but not limited to step therapy, prior authorization, and quantity limits
• Engaging with stakeholders in Council of Health Insurance to gather insights on medication prescribing expectations, barriers, challenges, and feedback
• Actively participating in the Pharmacy and Therapeutics Committee (PTC) and other committees, including the Therapeutics Assessment Committee (TAC) and the Value Assessment Committee (VAC)
• Managing prescriptions and organizing their data within the Council of Health Insurance
• Analyzing prescriptions and preparing reports to monitor new changes and developments
• Preparing a risk distribution model according to the analysis and in coordination with stakeholders
• Reviewing policies and clinical guidelines prepared by other entities and ensuring continuous compliance with any changes in the UDF
• Ensuring that the prepared drug guidelines align with current policies on similar topics
• Following up with relevant stakeholders on the proper implementation of the policy within specified timeframes
• Identifying barriers and/or enablers for ease of implementation and comparing them with different components or levels of implementation
• Collecting evidence and conclusions, ensuring that lessons learned are used in the preparation/updating of the DDF content
• Disseminating approved or updated policies, standards, and guidelines to relevant internal and external stakeholders for implementation and compliance
• Facilitating training and workshops to enable the implementation of the UDF
• Evaluating the impact of new guidelines and extracting lessons for future planning
• Responding to questions and complaints related to the UDF to provide answers and insights

Job Qualifications

Education, Certifications

• Bachelor’s degree in pharmacy or Doctor of Pharmacy (Pharm.D)
• Board Certification in Clinical Pharmacy. Or master’s degree or equivalent clinical pharmacy or master’s degree or equivalent in Pharmaceutical Economics
• Registered with the Saudi Commission for Health Specialties as a Senior Clinical Pharmacist
• Proficiency in English, both spoken and written (advanced)

Experience

• 3years of experience as a clinical pharmacist
• Experience with drug and therapeutics committees
• Experience in formulary management
• Knowledge of pharmaceutical preparations and disease states to provide consultation and advice to providers and members, and to recommend changes to the formulary
• Knowledge of pharmacy operations, techniques, and management methods
• Familiarity with scientific research principles and evaluation of guidelines and medical evidence
• Experience in developing, enabling, and monitoring health policies is preferred