Senior Manager: Medical Advisory Mngt

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 Head: Medical Risk and Business Solutions, the successful incumbent is accountable for providing leadership to the clinical research team and function and medical advisory services; for the development of evidence-based treatment protocol and of associated policies and procedures in order to meet the objectives of the fund. This role will coordinate across all areas aligned to claims processing, rehabilitation and future care in order to ensure overall service provider engagement and stakeholder satisfaction.

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.).

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.