Specialist Clinical Health Policy at Government Employees Medical Scheme RSA

The position of Specialist Clinical Health Policy is vacant. The Specialist Clinical Health Policy will report directly to the Manager Clinical Health Policy and form part of the Healthcare Management division . The position is based at Head Office in Pretoria.

The total remuneration package for this position negotiable based on qualifications and experience.

The Specialist Clinical Health Policy will be required to assist and support the Manager Clinical Health Policy through the implementation of the following Key Performance Areas (KPAs):

• Assist and contribute to the conduction of targeted research into local and international clinical guidelines and funding policies to ensure that Scheme funding decisions are based on best practice.
• Assist in critically analysing clinical literature and use of evidence-based principles to review and generate enhancements in funding protocols to manage and monitor clinical cost targets.
• Assist in the development and maintenance of adequate knowledge of data handling and interpretation of information translating interventions.
• Assist in the review of the Scheme’s funding policies, protocols and formularies.
• Assist in improving member value.
• Assist in the process for development and maintenance of Medical Advisory Services standard operating procedures and policies.
• Assist the Medical Advisory Services unit in providing clinical support to Healthcare Management and the Scheme’s other divisions.
• Assist in providing clinical support to the Scheme’s Disease Risk Management Programmes and Maternity Benefit
• Manage relationship building with key stakeholders.
• Perform Service Level Agreement quarterly site visits
• Support in the management and monitoring of SPNs to implement and give results within set targets
• Assist in the process for development and maintenance of Medical Advisory Services standard operating procedures and policies.

Qualification requirements are:

• Minimum 4-year Diploma / Degree in Medical Sciences or related fields
• Qualifications in Health Technology Assessment or Evidence-Based Medicine would be advantageous
• At least three (3) years of work experience in the healthcare funding / medical scheme industry
• Previous experience in a Health Policy Unit will be advantageous.
• Experience in the evaluation of health technology assessments would be advantageous.
• Must have experience in the development and presentation for reporting purposes.
• A good understanding of coding (Nappi, Tariffs, ICD10, CPT4, UPFS and more)
• A good understanding of the South African Healthcare Industry
• A good understanding of the Medical Schemes Act
• The ability to conduct research using a variety of academic and market-related resources

Desirable:

• Sound understanding of the medical schemes industry