Pharmaceutical Policy Specialist

Becoming a Pharmacy Integrity Manager involves overseeing the implementation of pharmacy policies and practices that align with regulatory requirements and company goals, while contributing to the development of health insurance products.

This role reports to the General Manager of Claims Integrity and Provider Capability Transformation and is a member of the CI&PCT Leadership Team. It plays a critical role in ensuring the safe, effective, and cost-efficient delivery of pharmaceutical benefits within health insurance companies.

You'll oversee the implementation of pharmacy policies and practices that align with regulatory requirements and company goals, while contributing to the development of health insurance products.

The role involves working closely with internal teams and stakeholders to optimise pharmaceutical benefits, manage medication-related risks, and maintain the drug database to ensure accurate payment for member benefits in compliance with health insurance policies and regulations.

You'll also provide guidance and approval for high-cost drug requests in accordance with hospital contract obligations and support initiatives aimed at improving health outcomes and controlling pharmacy-related costs.

This is a full-time, permanent position based in Melbourne, Sydney, Brisbane, or Adelaide. While primarily work-from-home, you may be required to attend the CBD office occasionally to collaborate with the broader team.

This role uniquely blends the clinical expertise of pharmacy with the strategic, corporate side of healthcare. In this position, you will:

• Manage and maintain the Drug Database and related collateral, ensuring medications listed for reimbursement align with pharmacy and product policies.
• Provide expert pharmaceutical advice to product teams, ensuring compliance with private health insurance legislation and regulations.
• Ensure adherence to PBS, TGA, and other regulatory standards relating to drug coverage and reimbursement.
• Review and assess high-cost drug claims for alignment with hospital agreements and health insurance policies.
• Analyse pharmaceutical data to identify trends, risks, or potential claims leakage.
• Advise the hospital contracting team on high-cost drug clauses during contract negotiations, offering insights into pricing, reimbursement models, and regulatory requirements.

To succeed in this role, you'll need:

• A Registered Pharmacist with a strong foundation in pharmacy practice and a strategic mindset that extends beyond day-to-day operations.
• 5+ years' experience across clinical, hospital, community, or industry settings.
• Strong knowledge of high-cost medicines, funding frameworks, and relevant regulations (PBS, TGA, private health insurance).
• Strategic thinker with the ability to challenge the status quo and shape forward-looking initiatives.
• Skilled communicator with proven influence across senior leaders, clinicians, and operational teams.
• Adaptable problem-solver who thrives in complex environments.
• Self-starter with a strong delivery focus; postgraduate qualifications (e.g. Masters, MBA, Health Economics) desirable.

The ideal candidate will possess a unique blend of clinical expertise, business acumen, and strategic thinking. If you're passionate about shaping the future of healthcare and have a knack for driving results, we encourage you to apply.

We're looking for someone who is adaptable, results-driven, and possesses excellent communication skills. If you're a self-starter with a passion for pharmacy and a drive to succeed, we want to hear from you.

Please note that we are an equal opportunities employer and welcome applications from all qualified candidates. We are committed to diversity and inclusion in the workplace.