Manager Clinical Advisor

3 weeks ago


Pretoria, South Africa Growthlink Consulting Full time

Key Performance Areas (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 Support the Medical Advisory Services Unit in the Schemes product development and benefit design

activities

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 the 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 Stakeholder Engagements

ü Represent the Healthcare Management division in internal forums

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

procedures and policies.

ü Provide clinical oversight and support to the Schemes internal processes, and support to the Schemes

other divisions in functions such as claims risk management, complaints process, health and wellness

campaigns, and outgoing Scheme communication

ü Assist in the resolution of all complaints; Council of Medical Scheme, internal escalations, Provider Relations,

and other complaints

ü Assist in the review of Competition Commission submissions

ü Pathology & Radiology Benefit Management including, but not limited to, review of billing rules and tariff files

ü Advise the Scheme on existing and new alternative reimbursement models

ü Provide clinical support in the review of Tariff and Billing rules

ü Provide clinical support in the management of the Schemes ambulatory, hospital and medicine benefits

ü Evaluation and analysis of proposals submitted to the Scheme and provide recommendations, including,

ü but not limited to: analysis of proposed appliances reimbursement, ARMS and value-based care models.

ü Provide clinical advice and recommendations for the identified strategic sourcing interventions

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

ü Sound understanding of the medical schemes industry


  • Clinical Advisor

    1 day ago


    Pretoria, South Africa The Aurum Institute Full time

    Work Description_ The Clinical Advisor is responsible for providing clinical advice and strategic direction to the to the support district/s and the appropriate internal and external clinical staff. They will building capacity among HCW to strengthen the TB HIV response and ensure clinical governance standards at all times. The position will assist the...


  • Pretoria, South Africa H2R Africa Full time

    valid registration with SANC. Also financial background working in the accounts department of a hospital is a crucial requirement. Minimum 2 years experience working within a private hospitals account department responsible for raising accounts with and billing medical schemes. Sound knowledge of the South African Healthcare industry and prevailing...


  • Pretoria, South Africa AJ Personnel Full time

    **Main purpose of the job**: - To provide leadership and expertise in the comprehensive clinical management of people living with HIV, with a focus on those with complex and advanced clinical disease, COVID-19, and supported by National TB/HIV/ACC Advisor and facility teams, within designated hospitals and clinics - Serve as the team lead for the allocated...


  • Pretoria, Gauteng, South Africa Innovative Financial Advisor Services Full time

    Job DescriptionWe are seeking a highly skilled and experienced Senior Financial Advisor to join our team at Innovative Financial Advisor Services. In this role, you will be responsible for providing comprehensive financial planning, investment advice, and retirement planning services to clients. Your primary goal will be to develop and maintain strong...


  • Pretoria, Gauteng, South Africa Dis-Chem Pharmacies Full time

    Dis-Chem Pharmacies is seeking a highly skilled Clinic Sister to join their team in managing a Primary Health Care Clinic.Job Summary:This role involves overseeing the daily operations of the clinic, ensuring that all services are available and patient care is enhanced. The ideal candidate will have a strong background in nursing and excellent communication...


  • Pretoria, Gauteng, South Africa LIFE Healthcare Group Full time

    A career opportunity exists for a Clinical Operations Manager to lead the Trauma Unit at Life Eugene Marais Hospital. The ideal candidate will oversee clinical practice and resources within the unit, driving quality, growth, and people objectives.Key ResponsibilitiesClinical Leadership: Implement nursing care plans, coordinate treatment delivery, and...


  • Pretoria, Gauteng, South Africa MNA Recruitment Full time

    The MNA Recruitment team is seeking a skilled Clinical Health Manager to join their team. As a Clinical Health Manager, you will play a critical role in providing high-quality patient care and disease management services.Key Responsibilities:Develop and implement comprehensive patient care plans that address chronic disease management and health education...


  • Pretoria, Gauteng, South Africa IQVIA - Quintiles and IMS Health, Inc. Full time

    Job OverviewClinical Trial Coordinators are key professionals in the medical research industry, responsible for ensuring the smooth execution of clinical trials.We are seeking an experienced Clinical Trial Coordinator with a strong background in Oncology to join our team at IQVIA - Quintiles and IMS Health, Inc.This role will involve providing expertise in...

  • Case Manager

    3 days ago


    Pretoria, South Africa care force Full time

    Our client, a managed care organisation based in Pretoria is looking for a Case Manager. This is an equal opportunity organisation with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries. Position: Case Manager (Member Management) Reporting to: Senior Specialist Clinical Management Location: On-site...


  • Pretoria, South Africa Spatology Recruit Full time

    Gauteng, Gauteng, PTA East R 15000 Monthly Basic Plus Commission (Commission) Upmarket aesthetic clinic in Lynwood, Pretoria is looking for an Aesthetic Clinic Manager. Also serving as a Backup Aesthetic Therapist. Position is available immediately. JOB REQUIREMENTS: Monday - Sat 9am - 6pm Cidesco or Itec qualification Diploma in Somatology Confident and...


  • Pretoria, South Africa Krypton Mining Full time

    **Key Responsibilities**: - Oversee the functioning of the Clinical Consulting Services sub-division, managing projects and day-to-day operations, including performance management, development, and implementation of operational plans. - Facilitate clinical support to other sub-divisions such as Benefits Management, Research & Monitoring, Legal Services,...


  • Pretoria, Gauteng, South Africa Ananzi Full time

    Company OverviewAs a leading global contract research organization, we offer a wide range of clinical development solutions to pharmaceutical, biotechnology, and medical device customers. Our team operates in over 90 countries, providing expertise in clinical trial conduct, data management, and regulatory submissions. We are committed to delivering...


  • Pretoria, South Africa HRInsync Full time

    **Advisor Channel Sales Manager** **Company** One of the largest private Medical Aid companies in SA. They have been established for 20 years and are striving to be #1 in SA. **Purpose** Responsibility and accountability for executing advisor contract management, advisor relationship management, acquisition of new advisors as well as new corporates,...


  • Pretoria, Gauteng, South Africa Mediclinic International Full time

    About the Role:We are seeking an experienced Clinical Case Manager to join our team at Mediclinic International. As a key member of our hospital operations team, you will be responsible for coordinating the case management process and ensuring seamless communication between all stakeholders.

  • Case Manager

    3 days ago


    Pretoria, South Africa H2R Full time

    Gauteng, Tshwane (Pretoria) - Monthly Cost To Company (Market related, Negotiable) Our client, who is in the Health Care Industry, has a vacancy for a Case Manager on a Contract Basis, with a possibility of it becoming permanent The Case Manager will have thorough, well-grounded clinical knowledge of hospital admissions, LOS and LOC Excellent knowledge of...


  • Pretoria, Gauteng, South Africa IQVIA Full time

    Job DescriptionAs a Centralized Monitoring Lead at IQVIA, you will be responsible for providing leadership of the centralized monitoring team to achieve the delivery of the project's overall objectives.You will have particular focus on leading/advising the centralized team towards solutions to clinical risks identified and facilitating successful...

  • Medical Advisor

    7 days ago


    Pretoria, South Africa Stafflink Recruitment Solutions Full time

    **About the role**: Medical company has a key opportunity for a medical adviser, reporting to the Head: Operations, to contribute to the effective management of clinical risk and the cost-effective and appropriate utilisation of scheme benefits. **Qualifications and experience**: An MB Ch.B. degree and registered with the HPCSA, as well as at least 8 years...


  • Pretoria, South Africa iMedrecruit Full time

    **Member Clinical Consultant (Pre-authorisations), Pretoria** Our client, focusing on a risk and clinical assessment offering, is requiring a Member Clinical Consultant. **Roles and Responsibilities (but not limited to)**: - Attend to incoming calls from healthcare service providers and members/ beneficiaries. - Verification of the eligibility of cover...


  • Pretoria, South Africa Thermo Fisher Scientific Full time

    Our team of colleagues in clinical research services are at the forefront of getting cures to market. We bring a high caliber of scientific and clinical expertise to the development of drugs that address the world’s most challenging health concerns. Our Clinical Research team, who powers our PPD® clinical research portfolio, are part of our leading global...


  • Pretoria, South Africa PPD Full time

    **JOB DESCRIPTION**: PPD is a leading global contract research organization providing comprehensive, integrated drug development, laboratory and lifecycle management services. At PPD, we are passionate, deliberate, and driven by our purpose - to improve health! This role is part of Accelerated Enrollment Solutions (AES), a business unit of PPD that offers...