Senior Manager Clinical Consulting Services

2 weeks ago

Johannesburg, Gauteng, South Africa Dukes Assignments Full time

SENIOR MANAGER:

CLINICAL CONSULTING SERVICES
The purpose of the job is to oversee the provision of Clinical services, administer the Prescribed Minimum Benefits (PMB) portfolio

to ensure medical scheme members are protected and their entitlements are guaranteed, and to develop and implement the

Prescribed Minimum Benefits regulation strategy

As a Senior Manager:
Clinical Consulting Services you will be responsible for:

  • Driving the implementation of Clinical Consulting Services planned activities and projects:
  • Oversee the functioning of the Clinical Consulting Services subdivision by managing the subdivision projects and dayto
- day function of the Clinical unit including performance management, development, and implementations of operational

plans.

  • Facilitate clinical support to other subdivision such as Benefits Management, Research & Monitoring, Legal Services etc.
  • Coordinating and participating in the development of Prescribed Minimum Benefit definition and review:
economic skills.

  • Support the analysis of Scheme Risk Measurement with epidemiological input (analyses and interpretation of disease
trends and costs.

  • Adjudication of clinical opinions:
  • To oversee the provision of evidence based, quality and meticulous clinical opinions.
  • To provide feedback on clinical enquiries and opinions to external stakeholders.
  • Coordinate Clinical Review Committee:
  • To coordinate clinical review committee meetings, monitor, report and manage Clinical Review Committee (CRC)
activities.

  • To participate in the appeals committee and provide clarity to the appeal committee on clinical opinions that informs rulings.
  • Provide support to National Department of Health:
  • To attend meetings and provide inputs to National Department of Health committees related to CMS work.
  • To implement adhoc national health policy projects and provide policy directive.
  • Undertake assignments/tasks allocated by line manager in accordance with CMS' operational requirements.

SKILLS AND KNOWLEDGE BASE

  • Bachelor of Medicine and Bachelor of Surgery (MBChB) or a degree in Medicine with post graduate training in Epidemiology
and Public Health at NQF level 8;

  • Masters' degree qualification in Public Health will be an added advantage;
  • Completed Internship and Community service;
  • A valid Health Professional Council of South Africa (HPCSA) Certificate; and
  • A minimum of 12 years' experience in the Medical Schemes and/or Healthcare environment, of which 5 years must be in
Evidence-Based Medicine & Clinical Management, and 7 years at Management/Supervisory level.

Training and Knowledge areas:

  • Knowledge of related legislation impacting on and influencing the functioning of the organisation (MSA, PFMA, CPA,
Constitution etc);

  • Knowledge of public health and health care industry;
  • Good knowledge of medical system and health management and clear understanding of the health policy implementation
landscape;

  • Stakeholder management;
  • Understanding of information management;
  • Understanding community challenges and opportunities relating to the mission of the organization; and
  • Computer Literacy.

Technical Skills and Behavioural Attributes:

  • Technical/professional knowledge and proficiency.
  • Policy development, maintenance, and implementation.
  • Strategic Management (decision making, planning, analysis, and implementation);
  • Financial management;
  • Risk, project, and programme management;
  • Communication, interpersonal and presentation;
  • Leadership and people management skills (mentoring and coaching).
  • Problem definition, analysis and decision making.
above position.

Council for Medical Schemes is committed to the principles of employment equity.

Job Types:
Full-time, Permanent

Salary:
Up to R121 447,00 per month

Ability to Commute:

  • Johannesburg, Gauteng (required)

Ability to Relocate:

  • Johannesburg, Gauteng: Relocate before starting work (required)
Application Deadline: 2024/02/23

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