Clinical Policy Developer TALENT POOL MMH251118-14

Role Purpose

To apply evidence-based medicine principles to develop, update, and maintain clinical tools, policies, and guidelines, whilst providing expert clinical support and resolving document-related queries.

Requirements

• Post graduate diploma or equivalent qualification in Health Technology Assessment is desirable.
• Bachelor of Nursing (BN) degree or a Diploma in Nursing (General, Midwife, Psychiatric Nurse and Community Health) and or relevant equivalent qualification is essential.
• Basic ICD10 coding course is essential.
• Registration as a Professional Nurse with the South African Nursing Council (SANC).
• 3 - 5 years experience in clinical development industry or a related field
• Clinical coding systems, including Current Procedural Terminology(CPT), International Classification of Diseases, 10th Edition (ICD-10), and Relative Value Scale Update Committee (RPL) coding standards.
• Demonstrated working knowledge of essential software tools, including MS Word, Access, SharePoint, and PowerPoint
• Advanced proficiency in Excel, including complex data analysis, formulae, and functions
• Familiarity with data analysis and clinical reporting methodologies
• Knowledge of the entire clinical policy development lifecycle, including the application of evidence-based medicine principles, regulatory compliance, and industry best practices, data analysis, and template systematisation
• Understanding of healthcare protocols, guidelines, and procedures

Duties and Responsibilities

PROCESS

• Conduct in-depth research, involve stakeholders, and utilise new technology to create evidence-based policies and disease management treatment plans.
• Regularly review and update existing policies, maintaining relationships with stakeholders and external consultants.
• Maintain a comprehensive central repository of health technology assessments and related materials.
• Actively participate in and contribute to continuous improvement initiatives within the organisation, exploring new methodologies and technologies to enhance the efficiency and effectiveness of policy development processes.
• Monitor changes in legislation and update policies accordingly to maintain compliance.
• Analyse healthcare data and feedback to make data-driven decisions, refining existing policies and developing new ones as needed.
• Maintain meticulous documentation of policy development processes, revisions, and updates.
• Implement a robust version control system to track changes, ensuring that all stakeholders have access to the latest versions of policies and guidelines.

CLIENT

• Monitor and enhance turnaround times and quality standards, resolving issues promptly to ensure superior client service.
• Manage client queries efficiently, tracking resolutions and utilising feedback for process improvement.
• Provide expert advice to clients, maintain relationships, negotiate service level agreements, and deliver on commitments to manage client expectations effectively.

PEOPLE

• Foster positive relationships, provide specialist guidance, and actively contribute to continuous innovation and development.
• Embrace change, support colleagues, and drive career development initiatives.
• Cultivate a work-centric culture that emphasises productivity, service excellence, and quality management.
• Collaborate with cross-functional teams, including medical professionals, researchers, and administrators, to gather diverse perspectives and insights.
• Foster effective teamwork and communication to ensure well-rounded and comprehensive policy development.
• Develop training programs and resources for internal staff to enhance their understanding of clinical policies and procedures.
• Conduct workshops and training sessions to ensure that employees across different departments are well-informed and compliant with the established policies.

FINANCE

• Contribute to budget development, minimising expenditure while aligning with operational plans.
• Identify cost-effective solutions, enhance operational efficiency, and comply with governance processes and legislation.
• Escalate policy and compliance issues, provide input into risk identification, and communicate recommendations for resolution.