Key Purpose :
The incumbent's role is to be the central player in the Clinical Advisory Benefit Services area to identify and ensure that optimal clinical decision making is made on every escalated case. The individual is directly responsible for aligning the teams within the division to fulfil strategic clinical needs within these sectors. Identifying and establishing best practice for effective clinical decision making and to fulfill the role as Head of the Medical Advisors and provide constant guidance and support to the Medical Advisors and to promote the use of Evidence Based Medicine in clinical decision making.
Key Outputs:
The successful applicant will be responsible for but not limited to the following job functions:
To ensure that principles of health economics and rationale resource allocation are incorporated into funding decisions. Constantly challenging and shaping the status quo.
Overseeing the success of the division by liaising with major stakeholders in the business.
Building effective relationships to create strategies and translate these into effective deliverables to ensure successful execution thereof.
Owning and chairing key forums with participants at an executive level.
Constant interaction with highly strategic thinkers and relationship building on an executive business level.
Developing strategic and operational plans to drive, lead, and represent all projects and key initiatives impacting the division.
Monitor the implementation of risk management strategies within the Division.
Keeping abreast with legislative and industry changes and how this affects your business units.
Analyzing and problem solving by identifying key issues and relationships from a base of information.
Effective decision-making by applying entrepreneurial knowledge and "out of the box" thinking and weighing up the risks involved.
Providing feedback to the clinical governance forum on a quarterly basis
Constantly remaining updated with medical technology, innovation and latest clinical information
Function as direct line manager for the Medical Advisors and Clinical Managers providing all necessary functional and administrative support to direct reports.
Work closely and collaboratively with the Head of CBAT, Legal Advisory and Medical review team leadership teams to ensure seamless processes and engagements between the areas.
To monitor performance within the department and ensure that trends are identified and corrective action is taken where necessary
SOPs: Responsible for SOPs related to CBA (these will be signed by individual managers prior to implementation)
Training: to support the Clinical Services department with developing training manuals, implementation of all training, quality initiatives, auditing and reporting including, error identifying, tracking and root cause analysis & trending. Overall responsibility for clinical training done within the Clinical Services department including the identification of training needs and the implementation of this training.
Audits: Responsible for making comments on all audits and findings and the associated corrective action plans. Audit report sign- off by DM before report goes to DGM
Integration: responsible for ensuring all CS operational and clinical initiatives and integration into broader business strategy and workflow integration to meet all SLA requirements and organizational requirements.
Operations Support: will be responsible for the CS operations meeting, data extraction and management, and support for the operations executive in preparing for the meeting (agenda, minutes & action implementation)
SharePoint: will be responsible for all knowledge management and document handling and repository in CS.
Knowledge and Skills:
Advanced knowledge in Clinical Procedures
Advanced knowledge in Discovery Products
Advanced knowledge in Risk Strategies
Intermediate knowledge of PMBs
Intermediate benefit knowledge
Intermediate knowledge of system architecture
Intermediate knowledge of Clinical Analytics
Advanced skills in Verbal and Written Communication, MS office, Paradigm and in-house IT systems
Advanced skills in Relationship Management
Intermediate skills in Analytics
Education and Experience:
The following requirements are essential:
Matric
MBBCH
2 years Clinical Experience
3 years Discovery Health medical advisor or related experience
1 year Stakeholder relationship management experience
Registered with relevant professional body
The following requirements will be advantageous:
Degree in Health Policy, Public health, Health Economics or Health Law and Bioethics
Knowledge of DH SOP's and Process experience (internal only)