Manager: Medical Management at Road Accident Fund

Key Performance Areas

Policy Review and Implementation

• Contribute to the development and implementation of claims medical operations policy, procedures and processes.
• Keep up to date with effective claims
• operations policy and practice execution strategies.

Medical Management

• Manage medical assessments including injury assessments of past and future medical care, preauthorization and clinical coding.
• Manage the assessment of the seriousness of medical injuries and determination of future care.
• Manage the implementation of the tariff, cost savings initiative recording and treatment protocol to ensure that all service providers adhere to the rules, and the tariff as guided by the RAF.
• Review assessment reports  and provide recommendations.

Exception handling

• Develop tracking methods to report analysis results in business case scenarios.
• Manage the development  and maintenance  of  formal  exception handling process within the medical management unit.
• Management of supporting policies and procedures in line with managing exception handling with the division 
• Represent  the  Fund  in  relevant

Reporting

• Prepare and submit regulation reports as and when required to provide progress updates and/or inform management decisions.
• Develop reports/ policies/ procedures and guide the process through the alignment of the documents to the overall RAF’s Strategy.

Stakeholder management 

• Facilitate and  manage communication with relevant internal and external stakeholders proactively   and   progressively manage the relationships.
• Communicate with all levels of stakeholder contact.
• Represent  the  Fund  in  relevant external activities and events.

 People Management

• Facilitate  and manage communication with relevant internal and external stakeholders proactively   and   progressively manage the relationships.
• Communicate with all levels of stakeholder contact.
• Represent  the  Fund  in  relevant external activities and events.

Qualifications and Experience

• Bachelor’s Degree/Advanced Diploma in Health Sciences or Medical  related qualification.
• Postgraduate in a Health Sciences or Medical related qualification will be an added advantage.
• Registration with HPCSA/SANCA.
• Relevant 6-8 years’ experience in a Medical Management related environment of which 2 (two) years must have been on a management/supervisory level/area of expertise.