Manager: Medical Advisor
3 weeks ago
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 Schemes 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 Schemes 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
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