Chief Healthcare Officer REF: GEMS01102024 at Government Employees Medical Scheme RSA

Key Performance Areas (KPAs)

• Develop, implement and maintain the Scheme’s overarching clinical strategies that align with organisational goals.
• Oversee the Scheme’s clinical function and integrate evidence-based clinical funding guidelines to ensure best practice.
• Oversee the Scheme’s Networks and Provider Relations Strategies, as well as the Scheme’s Provider Relations Officer (PLO) Programme strengthen stakeholder relationships and encourage collaboration and innovation.
• Develop and execute strategies to build and maintain robust healthcare networks, including hospitals, primary care, and specialist providers.
• Develop and implement comprehensive strategies for managing tariffs and billing rules aligned with organisational goals.
• Progressively implement the Scheme’s strategy on the implementation of Alternative Reimbursement Arrangements (ARM) with all hospital groups.
• Develop and implement policies for effective management of the Scheme’s medicine formularies and exclusion lists.
• Oversee the implementation and management of value-based active disease risk management initiatives, with the aim of improving patient outcomes.
• Oversee the development of the Scheme’s annual comprehensive sourcing strategies aligned with organisational goals.
• Maintain oversight of the Scheme’s managed care function and ensure that all contracted service provider network (SPN) functions and ensure compliance to Service Level Agreements (SLA).
• Foster strong relationships with healthcare providers to support strategic goals and initiatives, while utilising feedback from providers to inform decision-making and improve service deliver

Qualification requirements are:

• Postgraduate (NQF Level 8) MBCHB or equivalent in a related field/ Honours/ Professional Qualifications
• Strong understanding of the South African Healthcare and Medical Scheme Industry
• Twelve years (12) of functional experience with at least five to eight years (5-8) in a highly strategic Medical Scheme / Managed Healthcare Senior Management role including staff supervisory, budgetary, and management responsibility.

Desirable

• Master/ Postgraduate degree in Health Economics or Business Management