Manager: Tariff & Pharmaceuticals

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 Advisory Management, the successful incumbent is accountable for managing the processes related to the management and update of the Medical Tariffs, formulary and related aspects as part of the clinical leadership and also providing accountability to the clinical research tea functions and medical advisory services. The role will coordinate across all areas aligned to medical claims processing to ensure overall service provider engagement.

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.

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.
• Ability to manage Medical Tariffs, pharmaceutical policies and guidelines in line with evidence- based medicine.
• Computer literacy on Microsoft package (Word, Power-point, Excel, Outlook, and Internet Explorer)
• Ability to draft treatment protocols, policies and guidelines in line with evidence-based medicine.
• Ability to work within framework and scope of clinical research team.
• Knowledge of new and evolving practices in medicine to allow for sound clinical expertise.
• Strong analytic skills and knowledge of health care industry with ability to provide solutions to meet client needs and maximize value of deliverables
• Knowledge and understanding of the marketplace and professional trade associations, key people and companies
• Understanding of Good Clinical Practice and analysis of research papers.
• Good understanding of clinical coding crosswalks and norms e.g. ICD10, CPT, Nappi codes, etc.
• Understanding of the National Health Policy Framework and new healthcare industry development.
• Knowledge and understanding of the fundamental processes of business, their interaction, and the impact of the external /internal influences on clinical decision-making, and deadline.

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.