Job Description

Manager: Medical Advisory T.A.S.K Centurion Admin and Office Management ~ Medical / Emergency / Health / Lab
Centurion - GautengManager: Medical Advisory Centurion 3 year fixed term contractSalary: up to R1,028,791.00paOverview:Reporting to the Senior Manager: Claims, the successful incumbent will be accountable for supporting the Medical Management Unit (MMU) in implementing business processes using guidelines, policies and SOPs developed by the Medical Advisory Unit (MAU) and other company business units as part of the clinical leadership, and also providing medical advisory services. The role will co-ordinate across all areas aligned to claims adjudication, processing, rehabilitation and future care in order to ensure overall service provider engagement.Requirements and experience:

• A Medical Degree (MBChB) or equivalent.
• Current registration with the HPCSA as an Independent Medical Practitioner.
• Certificate in Evidence Based training (PTCMA) or Health Technology assessment (HTA) training or in progress of obtaining the qualification advantageous.
• Postgraduate qualification in Public Health, Business Administration or Public Management will be advantageous
• Relevant 6 - 8 years experience as a medical doctor in a managed care/ insurance/ healthcare environment, medical advisory work of which 2 years experience must have been on a management/ area of expertise.
• Experience in the development of treatment protocols, policies and working with a team of researchers to develop the treatment protocols (clinical coder, pharmacist, etc.).
• Experience in working with medicolegal matters would be an added advantage

Technical competencies required:

• Computer literacy on Microsoft packages (Word, PowerPoint, Excel, Outlook and Internet Explorer).
• Ability to draft treatment protocols, policies and guidelines in line with evidence-based medicine.
• Ability to work within framework and scope of clinical multi-disciplinary team.
• Knowledge of new and evolving practices in medicine to allow for sound clinical expertise.
• Strong analytical skills and knowledge of health care industry with ability to provide solutions to meet client needs and maximize value of deliverables.
• Knowledge and understanding of the marketplace and professional trade associations, key people and companies.
• Understanding of Managed Healthcare and Healthcare funding
• Knowledge and understanding of Case Management and Clinical Risk Management tools
• Understanding of Good Clinical Practice and analysis of research papers.
• Good understanding of clinical coding crosswalks and norms e.g. ICD10, CPT, Nappi codes, etc.
• Understanding of the National Health Policy Framework and new healthcare industry development.
• Knowledge and understanding of the fundamental processes of business, their interaction, and the impact of the external/ internal influences on clinical decision-making and deadline.
• Knowledge of the legislation governing company, policies and procedures.
• Knowledge and understanding of the company Amendment Bill of 2023 and its benefits.

Key Performance Areas:Provide Input to the Development of Clinical/ Treatment Protocols, Policies, Processes and SOPs

• Assist MAU in head office with input to update and develop treatment protocols relying on evidence-based medicine.
• Assist and provide support to MMU and other business units across the claims value chain in in decision making through policies and protocol.
• Update and refine healthcare policies in line with clinical development.
• Assist and provide support to Medical Management in decision making through policies and protocol.

Provide Clinical Expertise within the Clinical Multidisciplinary Team

• Serves as a medical expert and provide clinical leadership to the medical management team in the region.
• Ensure that clinical decisions taken in the unit align with local and international best practise, and company policies and SOPs.
• Facilitate and lead Case Discussion Meetings at the region
• Analyse clinical research data.
• Provide clinical support to the medical management team in providing responses to all clinically related queries from company stakeholders, e.g. attorneys, hospitals, etc.
• Assist in the development of clinical work templates.
• Check medical trends, experience and approaches and provide recommendations to the Senior Manager: Medical Management
• Assist in the development & implementation of health education programs for claimants and relevant stakeholders.

Administration and Report Writing.

• Collect patient statistics to inform future decisions.
• Write patient case notes and progress reports in accordance with the medico-legal specifications.
• Take part in departmental, regional and organizational meetings as delegated.
• Represent the Medical Management Unit internally and externally as delegated.
• Develop and submit required reports.
• Ensure processes are in place to have accurate and timeous claimant medical data and information

Stakeholder Relations.

• Build collaborative working relationships with different company business units for implementation purposes.
• Liaise with various internal and external service provider on medical matters.
• Provide medical and scientific advice to key internal stakeholders and develop proposals.
• Clinical query resolution

People Management

• Ensure the sourcing, development and retention of a high-performance team.
• Manage the recruitment of the operational workforce in line with employment equity targets.
• Manage staff in the department to ensure that they achieve their objectives in line with the strategic objectives of the company.
• Manage the implementation of human capital processes and procedures to control/regulate workplace conflict and/or institute corrective measures and consultation processes to address deviations from standards.
• Allocate, direct, motivate and evaluate subordinates to help them achieve their individual goals

NB: Should you not be contacted within 2 weeks of your application, please consider it as unsuccessful.Apply for this Job

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