Manager: Medical Advisor - External Stakeholder Support (Medical Doctor) – Medical Scheme – Pretoria

SUMMARY:
Manager: External Stakeholder Support (Medical Doctor) – Medical Scheme – Pretoria

POSITION INFO:

Manager: External Stakeholder Support (Medical Doctor) – Medical Scheme – Pretoria

KPAs

ü Manage the administrative function in the Medical Advisory Services business unit

ü Contribute to and conduct targeted research into local and international clinical guidelines and

funding policies.

ü Critical review and analysis of current cost drivers and trends and compare with those of local and

international sources for best practice.

ü Assist in the management and monitoring of clinical cost targets

ü Assist in developing and maintaining adequate knowledge of data handling and interpretation of information

translating interventions.

ü Chair and coordinate monthly SPN meetings

ü Perform Service Level Agreement quarterly site visits

ü Support in the management and monitoring of SPNs to implement and give results within set targets

ü Support in the management of divisional budget in line with budget allocation

ü Assist in improving member value

ü Monitor project/programme in conjunction with the internal Project Management Unit of the Scheme

ü Ensure that all relevant projects are carried out and finalised

ü Liaise with SPNs on operational matters

ü Represent the Healthcare Management Division at SPN and External Stakeholder Engagements,

including but not limited to Scheme’s Provider Summits, industry conferences, member Makgotlas,

SAPS, BHF, DPSA, various other external stakeholders

ü Represent the Healthcare Management in external stakeholder events

ü Assist in the process for development and maintenance of Medical Advisory Services standard operating

procedures and policies.

ü Assist the Medical Advisory Services in providing clinical support to Healthcare Management and

the Scheme’s other divisions in their external stakeholder-related matters

ü Support Provider Relations and Network engagements (quarterly hospital efficiency, provider society and

groups and other forums as required).

ü Clinical review of hospital and provider efficiency and network reports.

ü Advise the Scheme on existing and new alternative reimbursement models received from external

stakeholders

Requirements

ü Minimum MBChB/ MBBCh. Must be registered with the HPCSA

ü Qualifications in Health Technology Assessment or Evidence-Based Medicine would be advantageous

ü At least five (5) years work experience in the healthcare funding / medical scheme industry with at least

two (2) years at manager/supervisor level

ü Experience in the evaluation of health technology assessments would be advantageous

ü Must have experience in the development and presentation of management reports

ü A good understanding of coding (Nappi, Tariffs, ICD10, CPT4, UPFS and more

ü A good understanding of the South African Healthcare Industry

ü A good understanding of the Medical Schemes Act

ü The ability to conduct research using a variety of academic and market-related resources

Desirable

Sound understanding of the medical schemes industry