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Senior Manager Medical Advisor – Medical Scheme – Pretoria

Senior Manager Medical Advisor – Medical Scheme – Pretoria

Medical Advisor will report directly to the Chief Healthcare Officer and forms part of the Healthcare Management Division. The position is based in Head Office.

Key Performance Areas (KPAs):
 Attend and participate at various Scheme Forums, and make valuable contributions by providing expertise needed to give strategic and clinical advisory services.
 Provide clinical support within the Healthcare Management Division and the Scheme’s other divisions.
 Maintain relationships with various stakeholders within the healthcare industry and stay abreast of new developments that impact the medical aid industry.
 Provide oversight of the review of the Scheme’s funding policies, protocols and formularies.
 Ensure that all risk areas applicable to the Healthcare Management Division are identified, communicated and strategies put in place to mitigate risk.
 Manage the process for development and maintenance of Medical Advisory standard operating procedures and policies.
 Drive Medical Advisory efficiency to deliver clinically approved and evidence based quality outcomes.
 Direct all medical advisory activities to ensure successful attainment of strategic objectives.
 Ensure an efficient and well-functioning medical advisory platform.
 Contribute to targeted research into local and international clinical guidelines and funding policies.
 Evaluate current cost drivers, trends and compare with those of local and international sources for best practice.
 Manage the activities of the Scheme’s Expert Advisory Panels.
 Critically analyse medical literature and use evidence-based principles to review and generate enhancements in funding protocols.
 Review and provide expertise on new Health Technology assessments.
 Develop and maintain adequate knowledge of data handling and interpretation of information translating interventions.
 Perform tasks timeously, accurately and with necessary detail in response to issues raised.
 Review and ensure all CMS circulars are responded to and timeously implemented.
 Support Scheme’s ex gratia Committee and Sub-Committee.
 Timeously review and make funding recommendations on the Scheme’s ex gratia ratification cases, using evidence based medicine.
 Manage and maintain the Scheme’s Ex gratia guidelines
 Review and provide written responses to all CMS complains and appeals timeously.
 Assisting with all ad-hoc requests on any clinical and medical matters.
 Participates on interdisciplinary committees within the Scheme.
 Represent the Scheme and actively participate in DoH committees.
 Support Scheme’s product development and benefit design activities.
 Manage staff where necessary who are sub-ordinates.
 Represent the Scheme at various stakeholder engagements.
 Provide clinical support to the Scheme’s Disease Management Programmes.
 Manage training, development and mentorship of staff.
 Manage all the staff in the unit in accordance with the scheme’s HR Policy.

Job Requirements: 

Qualification, skills and competencies requirements are:
 MBCHB as a minimum qualification
 Must be registered with the HPCSA.
 Minimum 5 years work experience in the medical aid / managed care industry;
 Minimum 4 years as Manager / Senior Manager in the managed care / medical aid industry
 Experience in Clinical and Financial Risk Management.
 Benefit Design Experience.

Job Type: 

Permanent

Company Name: 

Growthlink Consulting

Company Location: 

Click here to apply

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