Senior Manager: Clinical Policy & Governance at Momentum Metropolitan Holdings Limited

Role Purpose    

• Provide senior specialist leadership for the Clinical Policy and Governance function within Health Risk Management by ensuring robust, evidence-based clinical policy, regulatory interpretation, and coding standards.
• The role is responsible for guiding health technology assessment, PMB and statutory interpretation, and clinical coding frameworks to inform benefit design, risk management, and strategic decision-making.

Requirements    

Qualification.

• Bachelor of Medicine or Bachelor of Surgery.
• Masters of Business Administration (MBA).
• Clinical Risk Management.
• Registation with the Health Professions Council of South Africa (HPCSA).
• Knowledge.
• Medical terminology, principles, processes and practices.
• Healthcare and clinical standards and best practices.
• Knowledge of the insurance industry.
• Relevant clinical and insurance legislation.

Experience.

• Minimum of 3 to 5 years’ experience in a people management or senior specialist leadership role, with demonstrated accountability for team leadership and delivery.
• Proven experience in clinical research, evidence appraisal, and health technology assessment, including translation of clinical evidence into policy or funding recommendations.
• At least 5 years’ experience within a medical scheme administrator, managed care, or health insurance environment, with exposure to PMB interpretation, benefit design, and regulatory requirements.

Duties & Responsibilities    

• Lead the design, implementation, and continuous improvement of clinical policies and protocols in alignment with statutory, regulatory, and business requirements.
• Oversee the end-to-end Health Technology Assessment (HTA) process to inform benefit design, policy updates, and clinical funding criteria.
• Engage with pharmaceutical, device, and clinical stakeholders to determine HTA outcomes and inform evidence-based policy positions.
• Ensure policies and decisions are compliant with CMS regulations, Scheme Rules, and relevant managed care legislation.
• Oversee clinical coding governance to ensure coding accuracy, alignment to benefit rules, and data integrity.
• Establish policy frameworks that guide consistent interpretation and application across internal business units and external stakeholders.
• Identify and assess emerging technologies and clinical trends to inform proactive policy and funding recommendations.
• Collaborate with internal governance committees and expert panels to support sound, transparent decision-making.
• Maintain external representation and benchmarking through professional bodies, HTA societies, and industry forums.
• Build and sustain collaborative relationships with key internal and external stakeholders, including product, operations, legal, and actuarial teams.
• Represent the organization in strategic engagements with pharmaceutical and medical device companies to assess new technologies, value propositions, within HRM mandate.
• Partner with clinical networks to promote consistency in clinical governance and managed care practices.
• Support business development and client engagement initiatives through expert clinical insights and evidence-based recommendations.
• Deliver thought leadership on policy trends, HTA methodologies, and clinical governance principles to business and industry audiences.
• Lead a multidisciplinary team comprising HTA specialists, clinical policy researchers, and clinical coding professionals.
• Foster a high-performance, learning-oriented culture that encourages innovation, accountability, and collaboration.
• Provide leadership, coaching, and professional development to strengthen technical and leadership capabilities within the team.
• Manage performance, ensuring alignment to strategic objectives and measurable business impact.
• Uphold Momentum’s values and drive an inclusive, respectful, and purpose-driven work culture.

Competencies    

• Business improvement.
• Strategy implementation.
• Business acumen.
• Leadership.
• Critical thinking.

Closing Date    

• 2026/01/30