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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