Manager External Stakeholder Support at Government Employees Medical Scheme RSA

The position of Manager External Stakeholder Support  is vacant. The Manager External Stakeholder Support will report directly to the Senior Manager Medical Advisory Services 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 Manager External Stakeholder Support will be required to assist and support the Senior Manager Medical Advisory Services through the implementation of the following Key Performance Areas (KPAs):

• Manage the administrative function in the Medical Advisory Services business unit
• Contribute to and conduct targeted research into local and international clinical guidelines and funding policies.
• Critical review and analysis of current cost drivers and trends and compare with those of local and international sources for best practice.
• Assist in the management and monitoring of clinical cost targets
• Assist in developing and maintaining adequate knowledge of data handling and interpretation of information translating interventions.
• Chair and coordinate monthly SPN meetings
• Perform Service Level Agreement quarterly site visits
• Support in the management and monitoring of SPNs to implement and give results within set targets
• Support in the management of divisional budget in line with budget allocation
• Assist in improving member value
• Monitor project/programme in conjunction with the internal Project Management Unit of the Scheme
• Ensure that all relevant projects are carried out and finalised
• Liaise with GEMS SPNs on operational matters
• Represent the Healthcare Management Division at SPN and External Stakeholder Engagements, including but not limited to GEMS Provider Summits, industry conferences, member Makgotlas, SAPS, BHF, DPSA, various other external stakeholders
• Represent the Healthcare Management in external stakeholder events
• Assist in the process for development and maintenance of Medical Advisory Services standard operating procedures and policies.
• Assist the Medical Advisory Services in providing clinical support to Healthcare Management and the Scheme’s other divisions in their external stakeholder-related matters
• Support Provider Relations and Network engagements (quarterly hospital efficiency, provider society and groups and other forums as required).
• Clinical review of hospital and provider efficiency and network reports.
• Advise the Scheme on existing and new alternative reimbursement models received from external stakeholders

Qualification requirements are:

• Minimum MBChB/ MBBCh. Must be registered with the HPCSA
• Qualifications in Health Technology Assessment or Evidence-Based Medicine would be advantageous
• At least five (5) years work experience in the healthcare funding / medical scheme industry with at least two (3) years at manager/supervisor level
• Experience in the evaluation of health technology assessments would be advantageous
• Must have experience in the development and presentation of management reports
• 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