14 hours ago
Job title : Senior Manager: Medical Advisory Mngt
Job Location : Gauteng, Centurion
Deadline : November 03, 2024
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Key Performance Areas
Governance of Clinical/ Treatment Protocols (Policies, Processes and SOPs)
- Devise and execute a plan to monitor development, updating and refining healthcare policies, processes, and protocol updates, on par with the latest technology and clinical developments in the industry.
- Assists and provide support to the medical management and claims assessment teams in decision making through policies and protocols.
- Manage decisions, actions, clinical information, communication, and support related to claims processes, treatment and procedure.
Management of Treatment Protocols
- Standardisation on clinical standards and practices in order to strengthen an integrated service model for all related stakeholders (clinical and non-clinical)
- Co-ordinate holistic treatment protocol approach that is capped and includes all service providers.
- Develop and deliver insightful, value-added solutions that address complex client issues.
- Navigate the market (including academic and specialist associations) in the effective and efficient standard treatment protocols. Nappi, ICD 10, CPT, orthotic, physiotherapy, occupational, etc.
- Serves as a scientific advisor and provide guidance to the team on implementation of treatment protocol.
- Investigate protocol related issues including protocol clarifications, inclusion/ exclusion determinations.
- Perform medical review of protocol.
- Perform medical review of adverse clinical coding.
Management of the Clinical Research Function
- Function as a clinical leader for the Fund
- Manage the analysis of clinical research data.
- Develop and manage a project plan.
- Provide guidance to the clinical research team.
- Advise, guide and support the clinical research team with clinical input and responses to all clinically related queries of RAF stakeholders e.g. attorneys, hospitals, etc.
- Check medical trends, experience and approaches.
Strategy Development and Operational Planning
- Guide the development and implementation of the departmens strategy and plan that ensure alignment with short-term and long-term objectives.
- Guide implementation of the overall strategic plan for the department.
- Guide the implementation of specific key performance indicators and measures against outcomes detailed in the departmental strategic plans.
Policy Review and Implementation
- Support the development and implementation of policy, procedures and processes for the business unit and ensure effective execution of policy and practices.
- Collaborate with appropriate structures to ensure effective execution of policy and practices.
- Ensure that all employees in the team know and understand the RAF policies.
Stakeholder Management
- Represent the organisation in various provider platforms, and stakeholder relations area in order to ensure that the RAF treatment protocols and policies are on par with the local treatment standards.
- Build collaborative working relationships with PMO, ICT, Post Claims Settlement etc. for implementation purposes.
- Provides medical and scientific advises to key internal and develop proposals.
General Administration
- Develop clinical work templates
- Respond to complicated clinical queries in writing, supporting teams
- Record keeping
- Serve as the clinical expert providing technical support to the medical management and claims assessment departments.
Reporting
- Update RAF Management on progress of Clinical Research Team protocol development with milestones.
- Report quarterly on progress with implementation of operational plans.
- Ensure development of functional reporting systems, project or performance reporting for management.
- Ensure the development of reports/ policies/ procedures and guide the process through the alignment of these documents to the overall RAF’s Strategy.
- Ensure regular and periodic reports are prepared and submitted as and when required to provide progress updates and/or inform management decisions.
Financial Management
- Ensure that the periodic financial and strategic goals of RAF as well as the performance expectations of the various teams are achieved.
- Report and review operations financial and non-financial goals.
- Ensure sufficient internal control measures are implemented for adherence to PFMA, RAF and other relevant legislation and regulation.
- Manage, monitor and control the department expense budget.
People Management
- Ensure the sourcing, development and retention of a high-performance team.
- Ensure the motivation, cohesiveness, and alignment of the organisation’s team members.
- Manage staff in the department to ensure that they achieve their objectives in line with the strategic objectives of the RAF.
Qualifications and Experience
- A Medical Degree (MBChB or equivalent).
- Registration with the HPCSA as a Medical Doctor
- Certificate in Evidence Based training (PTCMA) or Health Technology Assessment (HTA) training or in progress of obtaining the qualification.
- Postgraduate in Health Sciences or Medical related qualification.
- Business Administration/ Management post graduate qualification would be an advantage.
- Relevant 9 – 10 years’ experience as a medical doctor of which 3 years’ must be on a management level/ area of expertise in a managed care/ insurance/ healthcare environment, medical advisory work.
- Experience in the development of treatment protocols, policies, and working with a team of researchers to develop the treatment protocols (clinical coder, pharmacist, etc.).
How to Apply for this Offer
Interested and Qualified candidates should Click here to Apply Now
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