Job Location : Gauteng, JohannesburgDeadline : April 28, 2025Quick Recommended Links
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- To ensure that the scheme or organisation is protected from over-utilisation or inappropriate claiming by service providers that leads to abuse of member and scheme funds.
- Relevant medical degree, relevant qualification should be a MBChB degree.
- 6 - 8 years Managed Care experience preferred
Continuous improvement:
- Provide clinical inputs on ex-gratia funding requests
- Open, review and resolve all clinical queries and assessments through providing a clinical decision or requesting more information where required
- Implement practical solutions that use the specialist and departmental systems and processes
- Provide specialist input and recommendations to improve the efficiency, compliance and quality objectives related to the area of specialisation
- Identify problems and develop and propose solutions to present to appropriate leader or stakeholders
- Ensure day to day operational support required from area of specialisation is provided to enhance performance
- Support the identification, development and implementation of cost-effective processes to increase efficiency and reduce cost drivers related to area of specialisation
- Continuously review cost / benefit and Return on Investment within area of specialisation
- Engage with providers and pre-authorisation agents to build informed and supportive mutual relationships
- Maintain a high level of impact on other departments to support improved delivery
- Continually increase understanding of client and stakeholder needs, satisfaction and service delivery.
- Assess all high risk or high cost medical procedures to ensure appropriate authorisation and claiming is facilitated
- Provide clinical training / support to identified stakeholders
- Provide medical advisory services to relevant parties
- Ensure that adequate knowledge regarding specialisation is shared as required and maintained within the research library
- Provide advice and / or training as required
- Maintain, develop and implement specialist knowledge within the day to day operations of the organisation.
- Be a member of related professional bodies
- Ensure CPD (continual professional development) or similar accreditation requirements are met annually to ensure maintained specialist accreditation.
- Engage with and provide support to the established network of internal and external expert resources and partners.
- Provide Specialist expertise and ensure best practice related to specialisation is implemented in projects, when required
- Conform to project management disciplines when participating in projects
- Represent department or project on appropriate committees related to area of specialisation.
Competency Requirements
- Knowledge and application of relevant legislation
- Knowledge of device industry
- Ability to provide appropriate medical direction and advisory services
- Knowledge and application of clinical principles and processes
- Knowledge of clinical and funding protocol development
- Clinical research and assessment
- Knowledge of scheme rules and contractual negotiations
- Analytical skills
- Business Writing Skills
- Communication Skills
- Computer Technology Skills
- Attention to Accuracy and Detail
- Problem solving and decision making skills
- Numerical Ability
- Customer Focus
- Medical / Healthcare jobs
