Hospital Benefit Management at AfroCentric Group

Accountability for strategic and functional leadership and management of the HBM business unit in line with the overall managed care strategy, including ongoing development and delivery of efficient and effective services as contractually required as well as internal and external stakeholder relationship management, with the objective of promoting sustainable and equitable funding of affordable, costeffective quality healthcare on behalf of client schemes.

Experience

• 12 years’ experience in the healthcare environment, including at senior management level.
• This also includes experience of clinical practice as well as managed care experience in a funding or hospital environment.

Qualifications

• A clinical degree. A business qualification will be advantageous. Current relevant registration with professional body.

Accountabilities

Compliance and Risk Management:

•  Legal, statutory and regulatory compliance (public accountability) on all requirements are implemented and maintained for function
•  Structures and frameworks for risk controls and governance within the function are implemented
•  Ensure function is a key contributor in terms of social awareness and corporate citizenship

Divisional Leadership:

•  Accountability for the function's performance, within the agreed strategic framework
•  Develop and retain skilled, engaged employees
•  Promote transformation

Financial Management:

•  Accountability for functional budget and overall financial management

Operating Model:

•  Provide strategic and implementation input into stakeholder models and initiatives
•  Ensure the short and long term sustainability of the division and networks that are established
•  Develop business plans to implement the defined integrated functional plans with peer divisions or functions
•  Optimise the function's core internal processes and internal supply chain and resolve functional operating conflicts

Stakeholder Management:

•  Build and maintain relationships with stakeholders to support the development of mutually beneficial and supportive relationships
•  Ensure appropriate, active and informative relationships with relevant stakeholders are in place
•  Drive delivery of customer expectations within organisational quality and quantity standards

Strategy Implementation:

•  Remain up to date with macro and microeconomic conditions, legislation, competition, market sentiment and the industry in general, to anticipate and plan for circumstances that may influence the development and implementation of the functional strategic plan
•  Provide input into and develop the functional strategic plan
•  Ensure strategy is implemented in a manner that supports operational and market imperatives
•  Communicate strategic context and strategic implementation plans to ensure operational best practice and continuous improvement

Position Specific Outputs

• Accountable for the ongoing development cycle of the HBM business model as part of the AfroCentric managed care strategy.
• Provide leadership in terms of contributing to and implementing corporate strategy, governance and risk management as well as
• stakeholder management.
• Accountable for the performance of senior managers, managers, team leaders and case managers, coordinated with dedicated medical advisory services.
• Coordinate the hospital risk capability, drawing in the inhospital case management and alternatives to hospitalisation and related strategies
• and operations.
• Manage the implementation and development cycle of the operating model’s functional plans with transparent funding protocols, automated decisioning, and exception case management, advanced analytics, provider and beneficiarycentric communications and information sharing.
• Build and maintain appropriate, active and informative mutually beneficial relationships with relevant stakeholders
• (must have a stakeholder map and management plan).
• Ensure compliance with clinical and financial risk management (managed care) principles.
• Ensure customer mandated funding protocols, scheme rules and operational processes are followed.
• Liaise with leaders, peers and staff to achieve customercentric operational performance and satisfaction goals.
• Ensure client service levels are met.
• Incorporate the customer experience strategy of the organisation and its metrics.
• Ensure compliance with clinical and financial risk management (managed care) principles.
• Ensure compliance with Medscheme’s operational risk and governance structures, measures and frameworks and Medscheme’s clinical and
• nonclinical case management standards as defined in policy documents, KPIs, elearning and training manuals

Competency Requirements

Attribute:

•  Entrepreneurship (Exec Man / GM)
•  Influence (Exec Man / GM)
•  Credibility (Exec Man / GM)
•  Ownership (Exec Man / GM)
•  Collaboration (Exec Man / GM)

Knowledge:

•  Knowledge, application and compliance to relevant legislation and regulations
•  Clinical funding protocols and case management decision support methods
•  Application of financial and risk assessment methodology
•  Knowledge and application of clinical principles and processes

Skill:

•  Knowledge and application of benefit risk management concepts
•  Knowledge and application of scheme rules
•  Principles and processes of clinical intervention in a structured environment
•  Communication Skills
•  Computer Technology Skills
•  Executive Business Writing Skills
•  Competence to guide, direct sustainability productivity & cost effectiveness
•  Problem Solving
•  Ability to Develop, Guide and Direct liaison between various stakeholders
•  Attention to Accuracy and Detail
•  Data gathering and analysis
•  Customer Focus
•  Financial Acumen