Senior Manager: Medical Advisory Mngt at Road Accident Fund

Key Performance Areas

Governance of Clinical/ Treatment Protocols (Policies, Processes and SOPs)

• Devise and execute a plan to monitor development, updating and refining healthcare   policies, processes, and protocol updates, on par with the latest technology and clinical developments in the industry.
• Assists and provide support to the medical management and claims assessment teams in decision making through policies and protocols.
• Manage decisions, actions, clinical information, communication, and support related to claims processes, treatment and procedure.

Management of Treatment Protocols

• Standardisation on clinical standards and practices in order to strengthen an integrated service model for all related stakeholders (clinical and non-clinical)
• Co-ordinate holistic treatment protocol approach that is capped and includes all service providers. 
• Develop and deliver insightful, value-added solutions that address complex client issues.
• Navigate the market (including academic and specialist associations) in the effective and efficient standard treatment protocols. Nappi, ICD 10, CPT, orthotic, physiotherapy, occupational, etc.
• Serves as a scientific advisor and provide guidance to the team on implementation of treatment protocol.
• Investigate protocol related issues including protocol clarifications, inclusion/ exclusion determinations.
• Perform medical review of protocol.
• Perform medical review of adverse clinical coding.

Management of the Clinical Research Function

• Function as a clinical leader for the Fund
• Manage the analysis of clinical research data.
• Develop and manage a project plan.
• Provide guidance to the clinical research team. 
• Advise, guide and support the clinical research team with clinical input and responses to all clinically related queries of RAF stakeholders e.g. attorneys, hospitals, etc.
• Check medical trends, experience and approaches.

Strategy Development and Operational Planning

• Guide the development and implementation of the departmens strategy and plan that ensure alignment with short-term and long-term objectives.
• Guide implementation of the overall strategic plan for the department.
• Guide the implementation of specific key performance indicators and measures against outcomes detailed in the departmental strategic plans.

Policy Review and Implementation

• Support the development and implementation of policy, procedures and processes for the business unit and ensure effective execution of policy and practices.
• Collaborate with appropriate structures to ensure effective execution of policy and practices.
• Ensure that all employees in the team know and understand the RAF policies.

Stakeholder Management

• Represent the organisation in various provider platforms, and stakeholder relations area in order to ensure that the RAF treatment protocols and policies are on par with the local treatment standards. 
• Build collaborative working relationships with PMO, ICT, Post Claims Settlement etc. for implementation purposes.
• Provides medical and scientific advises to key internal and develop proposals.

General Administration

• Develop clinical work templates
• Respond to complicated clinical queries in writing, supporting teams
• Record keeping
• Serve as the clinical expert providing technical support to the medical management and claims assessment departments.

Reporting

• Update RAF Management on progress of Clinical Research Team protocol development with milestones. 
• Report quarterly on progress with implementation of operational plans.
• Ensure development of functional reporting systems, project or performance reporting for management.
• Ensure the development of reports/ policies/ procedures and guide the process through the alignment of these documents to the overall RAF’s Strategy.
• Ensure regular and periodic reports are prepared and submitted as and when required to provide progress updates and/or inform management decisions.

Financial Management

• Ensure that the periodic financial and strategic goals of RAF as well as the performance expectations of the various teams are achieved.
• Report and review operations financial and non-financial goals.
• Ensure sufficient internal control measures are implemented for adherence to PFMA, RAF and other relevant legislation and regulation.
• Manage, monitor and control the department expense budget.

People Management

• Ensure the sourcing, development and retention of a high-performance team.
• Ensure the motivation, cohesiveness, and alignment of the organisation’s team members.
• Manage staff in the department to ensure that they achieve their objectives in line with the strategic objectives of the RAF.

Qualifications and Experience

• A 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.
• Postgraduate in Health Sciences or Medical related qualification.
• Business Administration/ Management post graduate qualification would be an advantage.
• Relevant 9 – 10 years’ experience as a medical doctor of which 3 years’ must be on a management level/ area of expertise in a managed care/ insurance/ healthcare environment, medical advisory work.
• Experience in the development of treatment protocols, policies, and working with a team of researchers to develop the treatment protocols (clinical coder, pharmacist, etc.).