Manager: Tariff & Pharmaceuticals at Road Accident Fund

Key Performance Areas

Develop and Update Medical Tariffs and Relate Pricing

• Serves as a medical expert and provide clinical leadership within the medical advisory team. 
• Analyse clinical research data.
• Provide clinical support to the clinical research team responses to all clinically related queries of RAF stakeholders e.g. attorneys, hospitals, etc.
• Check medical trends, experience and approaches and provide recommendations to the Senior Manager: Medical Advisory Management.
• Assist in the development of clinical work templates.
• Develop & implement health education programs for claimants and relevant stakeholders.

Develop Pharmaceutical Benefit Management (PBM) and Related Tools

• Update and manage tools for managing acute and chronic medication.
• Provide training and support to medical management in the use of PBM tools and decision making aligned to regulated rates

Clinical Research, Expertise and Support within the Clinical Research Team

• Serves as a medical expert and provide clinical leadership within the medical advisory team.
• Analyse clinical and pharmaceutical research data.
• Provide clinical support to the clinical research team responses to all clinically related queries.
• Review medical trends, experience and approaches and provide recommendations to the Senior Manager.
• Assist in the development of clinical work templates.

Policy Review and Implementation

• Update and develop medical tariffs based on healthcare policies in line with clinical development.
• Provide training and support to medical management in the use of medical tariffs and decision making aligned to regulated rates.
• Assist in managing decisions, actions, clinical information, communication and support related to claims processes, treatment and procedure.
• Develop and update medical tariffs for the RAF to assist in reduction of medical costs.

Stakeholder Management

• Liaise with key external and internal service providers on Medical Tariffs and drive adoption and adherence.
• Build collaborative working relationships with medical management for implementation purposes.
• Use clinical acumen to build and function in strong teams to ensure high performance.

Reporting

• Collection of patient statistics to inform future decisions.
• Compile monthly reports.
• Develop and implement health education programs for claimants and relevant stakeholders.

People Management

• Ensure the sourcing, development and retention of a high-performance team.
• Manage staff in the department to ensure that they achieve their objectives in line with the strategic objectives of the RAF. Manage the implementation of human capital processes and
• procedures to control/ regulate workplace conflict and/or institute corrective measures and consultation processes to address deviations from standards.
• Allocate, direct, motivate and evaluate subordinates to help them achieve their individual goals.

Qualifications and Experience

• Medical Degree (MBChB) or equivalent.
• Registration with the HPCSA as a Medical Doctor.
• Certificate in Evidence Based training (PTCMA) or Health Technology assessment (HTA) training or in progress of obtaining the qualification advantageous
• Postgraduate qualification will be advantageous.
• Relevant 6 - 8 years’ experience as a medical doctor in a managed care/ insurance/ healthcare environment, medical advisory work of which 2 years’ experience must have been on a management/ supervisory level/ area of expertise.
• Experience in the development and application of medical tariffs, pharmaceutical drug reviews policies, and working with a multi-disciplinary team of researchers to develop the medical tariffs.