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Group Functional Professional Specialist: Health Policy Unit

Position Purpose

To research, develop, review and communicate reimbursement guidelines and policy for the company and clients, including drug and technology policy.
Such policy to be communicated to clients, internal business units and external stakeholders, as required
To develop and maintain a clinical governance framework for managed care

Experience – 5 – 7 years experience in clinical policy development at senior management level

Qualifications – MBCHB plus a post-graduate qualification

Grade – B1M3

Accountabilities
Drive customer-centricity:

• Maintain a high level of inter-departmental cooperation in order to ensure professional excellence
• Continuously review client and stakeholder needs, satisfaction and service delivery, through review of reports and participating in and/or conducting client and stakeholder forums
• Build and maintain an established network of internal (peers and executives) and external expert resources and partners (through professional bodies and forums)
• Represent the brand in professional networks

  Financial Efficiencies:

• Ensure all improvements made to the division or organisation support the organisation to increase profit, maintain quality and/or reduce risks
• Where appropriate, compare allocated budgets with actuals and highlight variances
• Continuously review cost / benefit and ROI

  Knowledge management:

• Create and maintain best practice policies, approved by Executive, for area of specialisation
• Implement appropriate communication methods (such as reporting) to ensure understanding of implemented changes and sharing of business information with staff and executives
• Track, document and display best practice efficiency
• Provide advice and / or training in area of specialisation as required

  Maintain expertise level:

• Provide leadership and technical expertise on day to day clinical decision making, where escalated
• Be a member of and make regular contributions to professional bodies, including publication of articles and research findings
• Ensure CPD (continual professional development) or similar accreditation requirements are met annually to ensure maintained specialist accreditation

  Own improvement activities within operational model of division:

• Ensure alignment of policy development with company and individual client scheme strategy
• Communicate, operationalise and defend clinical reimbursement policies
• Ensure and maintain total understanding of the operational model
• Ensure and maintain comprehensive knowledge of potential benefits and constraints in area of specialisation and compare operational performance with principles, theory and practice to enable best practice
• Compare operational performance with principles, theory and practice in area of specialisation
• Continuously review the integrated model with reports and experts to identify issues and solutions
• Provide expert opinion in area of specialisation
• Document any specialist models, improvement plans and activities intended for implementation in the division or organisation to obtain Executive support
• Ensure that standards are implemented and design and development work are completed within organisational guidelines
• Continue practical work in area of specialization

Position Specific Outputs

• Ensure that all policy is evidence-based and regularly reviewed. Where insufficient evidence exists, ensure that a position
  statement is discussed and drafted
• Clinical governance framework to include clinical advisory escalation processes; oversight in escalation and policy implementation
  forums; quality outcomes review; review policy alignment of reimbursement models
• Regular engagement with relevant regulatory and professional bodies

Position specific Outputs

• Provide leadership and custody for clinical governance within the group
• Provide clinical leadership and position the unit as a Centre of clinical excellence to fulfil client and group objectives
• Ensure that all policy is evidence-based and regularly reviewed. Where insufficient evidence exists, ensure that a position
  statement is discussed and drafted
• As a leader for medical advisory within the group, ensure processes are in place to enable efficiencies, clinical leadership while maintaining lines of communication with providers
• Continuously scan the environment for trends , discussion and stakeholder position that affect clinical policy , and respond to such with policy positions for the group
• Clinical governance framework to include clinical advisory escalation processes; oversight in escalation and policy implementation
  forums; quality outcomes review; review policy alignment of reimbursement models
• Regular engagement with relevant provider societies, regulatory and professional bodies
• Represent the company in clinical committees and where necessary boards that drive the clinical leadership of the organization

Competency Requirements
Attribute:

• Credibility (Exec Man / GM)
• Collaboration (Exec Man / GM)
• Influence (Exec Man / GM)
• Entrepreneurship (Exec Man / GM)
• Ownership (Exec Man / GM)
  Knowledge:
• Knowledge and application of relevant legislation
  Skill:
• Communication Skills
• Computer Technology Skills
• Executive Business Writing Skills
• Financial Acumen
• Change Management
• Innovates and Takes Risks
• Ability to Develop, Guide and Direct liaison between various stakeholders
• Quality Orientation
• The ability to direct health risk solutions for a medical scheme
• Ability to Guide, Direct Policy development and implementation
• Cost-benefit analysis modelling, as well as the use of statistical software

Send your updated CV  to Vicki  at vicki@medicalcareers.co.za

Subject : Group Specialist