Manager Medical Process Guidance at Road Accident Fund

Job description

Purpose of the Job: To provide guidance to operations on the medical aspects to claims processing.

Key Performance Areas

• Document processes and SOP
• Develop and maintain a practical guideline for staff
• Create and maintain templates for operations
• Give input into the development of training material
• Analysis of trends
• Ensure standard practices in applying the assessment method in claims administration
• Ensure standard practices in case management
• HPCSA rulings
• Key trends in assessment
• Research developments in assessment methods
• Review and recommend on assessments referred from operations
• Develop and manage relationships with stakeholders and facilitate ongoing meetings with them to keep updated.
• Manage the agreement with HPCSA
• Create and maintain service provider database. Confirming of service provider practice numbers and accreditation.
• Create and maintain a database of HPCSA rulings. Report on the outcomes
• Negotiate with relevant stakeholders with regards to provision on medical services Facilitate and coordinate ongoing briefing meetings with relevant stake holders
• Implement the budget plan to ensure that budgets are in line with operational requirements
• Manage and monitor budget and ensure that the budget meet with PFMA requirements

Qualifications and Experience

• Degree/ Diploma in medical related field (nursing, occupational therapy)
• 5 years experience in the field of expertise.
• 2 years supervisory experience
• Prior exposure to tariffs

Technical and behavioral competencies required

• Ability to engage in multiple initiatives simultaneously
• Excellent oral, written and presentation skills
• Good Interpersonal skills
• Work effectively as a team player
• Attention to detail
• Assertiveness
• Team leading / working
• Oral persuasiveness
• Professionalism
• Self management
• Technical ability
• Willingness to travel