Head of Clinical Benefit Advisory Team

3 weeks ago

Sandton, South Africa Discovery Ltd. Full time

**Business Unit**:Discovery Health

**Function**:Clinical

**Date**:5 Mar 2025

**Head of Clinical Benefit Advisory Services**

**About Discovery**
- Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.

**About Clinical Benefit Advisory Team**

**Key Purpose**:
**Key Outputs**:
The successful applicant will be responsible for, but not limited to, the following job functions:
**Funding decision making**:

- Ensure that principles of health economics and rationale resource allocation are incorporated into funding decisions.
- Provide oversight and guidance for all complex escalated funding requests that are managed in the Clinical Benefit area.
- Lead the management of Executive Case Review (ECR):

- As a member of the ECR committee, attend and participate in ECR discussions and represent the CBA area with voting rights.
- Draw up and present/circulate the annual ECR report providing feedback to the ECR Committee regarding funding decisions made.

**Relationship and stakeholder engagements and management**:

- Building effective relationships to create strategies and translate these into effective deliverables to ensure successful execution thereof.
- Drive and attend relevant meetings with CCE and other major stakeholders.
- Establish positive working relationships with healthcare providers including key opinion leaders and academics.
- Constant interaction with highly strategic thinkers and relationship building on an executive business level.
- Develop and deepen relationships with Ops Execs and Risk colleagues.
- Attend relevant multi-disciplinary meetings as a brand ambassador and to nurture relationships.
- Form an integral part of the PMB steercom guiding funding protocols to ensure legal compliance with the Medical Schemes Act

**Management of Business unit operational processes and performance**:

- Oversee the management of all operational requirements for CBAT, including but not limited to:

- SOPs: Drive SOP management by CBAT leadership team
- Own and manage any CBAT leadership operational meetings.
- Drive all knowledge management and document handling and repository on central business platforms.
- Ensure and Oversee fulfillment of iQS processes
- Ensure and oversee incentive management
- Responsible for the monitoring of performance within the department and ensure identification of key trends, and implementation of corrective action where necessary.
- Responsible for providing insights on all audits and findings, and sign-off thereof.

**Reporting**:

- ensure all reports are produced, shared and presented as required before relevant audience and in different forums including monthly reports
- Oversee all reporting on Clinical Exceptions made in CBAT, Ex Gratia and High risk cases for the DHMS Clinical Governance and ethics committee
- Providing feedback to the clinical governance forum on a quarterly basis

**Strategic focus**:

- Responsible for developing strategic and operational plans to drive, lead, and consistently improve complex clinical decision making, and outcomes of Disputes and Complaints from the Council of Medical Schemes,within the business unit.
- Keeping abreast with legislative and industry changes and how this affects your business units.
- Constantly remain updated with medical technology, innovation and latest clinical information

**Integration**:

- responsible for ensuring all CBAT operational and clinical initiatives are integrated into broader business strategy and workflow to meet all SLA requirements and organizational requirements.
- Feedback to the DiscoveryCare and Service teams to improve processes that enhance customer experience based on escalations received.Involve Head of Clinical Strategy and Clinical Center of Excellence where additional advice and steer is required for complex case resolution.

**Leadership**:

- Lead teams effectively to drive best performance and bring the best out of people

**Human Resource management**
- Ensure timeous and prudent recruitment, including building talent pipelines for the business unit
- Ensure continuous support and upskill of all staff in the Clinical Benefit Advisory area.

**Training**:

- Continuous identification of training needs for the business unit and other clinical areas and stratetig support on training delivery

**Manage budget**

**Competencies**:
**Role Specific Behaviours**
- Ensures accountability.
- Action oriented
- Manages ambiguity.
- Attracts top talent.
- Business insight
- Collaborates
- Communicates effectively.
- Manages complexity.
- Man

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