Manager: Medical Management

The Road Accident Fund’s mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.

 Purpose of the Job: Reporting to the Senior Manager: Medical Management, the successful incumbent is accountable to manage the medical management capability in supporting the claims operations.

Key Performance Areas

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.

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.
• Manage the documentation and regular updating of the exception handling process.

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.

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.
• Develop functional reporting systems, for management, projects or performance reporting.

Stakeholder Management

• Facilitate and manage communication with relevant internal and external stakeholders proactively and progressively manage the relationships.
• Manage relationships with vendors, service providers or procurement teams and ensure that all relevant procured items are invoiced and paid on time.

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.
• Allocate, direct, motivate and evaluate subordinates to help them achieve their individual goals.

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 years must have been on a management/supervisory level/ area of expertise.

Technical and Behavioral Competencies Required

• Resilience.
• Network and alliance.
• Employee engagement.
• Ethics and values.
• Change management.
• Critical and innovative thinking
• Policy conceptualisation and formulation.
• Risk Management.
• Stakeholder development and relations.
• Reporting.
• Claims management process/ processes and systems.
• Medical Management.
• Medical bill reviewing.
• Medical case management.
• Complex problem identification, solving and decision making.
• Customer value proposition.
• Good financial management skills.
• Strong analytical capabilities.
• Knowledge of Motor Vehicle Accident legislation.
• PFMA knowledge.

NB: “RAF offers Total Employment Cost packages with no additional contributions from the Employer, successful candidates are required to structure their packages in a manner that will suit their needs”. 

The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.

Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful

Security Vetting shall be conducted on all prospective employees

It is the applicants’ responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.