Discovery's core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.
About Clinical Benefit Advisory Team
The Clinical Benefit Advisory Team (CBAT), a subsidiary of Discovery Health, comprises Medical and Legal Advisors who offer clinical and legal expertise on complex cases. The Council Liaison Managers serve as the bridge between Discovery Health and the Council for Medical Schemes, providing support to the Legal Advisors. Additionally, the Medical Review Consultants ensure that clinical cases are thoroughly reviewed, and appropriate decisions are made. The team operates regionally in Sandton and Cape Town.
Key Purpose:
The incumbent's role is to be the central player in the Clinical Advisory Benefit Services area to identify and ensure that optimal clinical decision making is made on every escalated case. The individual is directly responsible for aligning the teams within the division to fulfil strategic clinical needs within these sectors. Identifying and establishing best practice for effective clinical decision making and to fulfill the role as Head of the Medical Advisors and provide constant guidance and support to the Medical Advisors and to promote the use of Evidence Based Medicine in clinical decision making.
Key Outputs:
The successful applicant will be responsible for but not limited to the following job functions:
To ensure that principles of health economics and rationale resource allocation are incorporated into funding decisions. Constantly challenging and shaping the status quo.
Overseeing the success of the division by liaising with major stakeholders in the business.
Building effective relationships to create strategies and translate these into effective deliverables to ensure successful execution thereof.
Owning and chairing key forums with participants at an executive level.
Constant interaction with highly strategic thinkers and relationship building on an executive business level.
Developing strategic and operational plans to drive, lead, and represent all projects and key initiatives impacting the division.
Monitor the implementation of risk management strategies within the Division.
Keeping abreast with legislative and industry changes and how this affects your business units.
Analyzing and problem solving by identifying key issues and relationships from a base of information.
Effective decision-making by applying entrepreneurial knowledge and "out of the box" thinking and weighing up the risks involved.
Providing feedback to the clinical governance forum on a quarterly basis
Constantly remaining updated with medical technology, innovation and latest clinical information
Function as direct line manager for the Medical Advisors and Clinical Managers providing all necessary functional and administrative support to direct reports.
Work closely and collaboratively with the Head of CBAT, Legal Advisory and Medical review team leadership teams to ensure seamless processes and engagements between the areas.
To monitor performance within the department and ensure that trends are identified and corrective action is taken where necessary
SOPs: Responsible for SOPs related to CBA (these will be signed by individual managers prior to implementation)
Training: to support the Clinical Services department with developing training manuals, implementation of all training, quality initiatives, auditing and reporting including, error identifying, tracking and root cause analysis & trending. Overall responsibility for clinical training done within the Clinical Services department including the identification of training needs and the implementation of this training.
Audits: Responsible for making comments on all audits and findings and the associated corrective action plans. Audit report sign- off by DM before report goes to DGM
Integration: responsible for ensuring all CS operational and clinical initiatives and integration into broader business strategy and workflow integration to meet all SLA requirements and organizational requirements.
Operations Support: will be responsible for the CS operations meeting, data extraction and management, and support for the operations executive in preparing for the meeting (agenda, minutes & action implementation)
SharePoint: will be responsible for all knowledge management and document handling and repository in CS.
Knowledge and Skills:
Advanced knowledge in Clinical Procedures
Advanced knowledge in Discovery Products
Advanced knowledge in Risk Strategies
Intermediate knowledge of PMBs
Intermediate benefit knowledge
Intermediate knowledge of system architecture
Intermediate knowledge of Clinical Analytics
Advanced skills in Verbal and Written Communication, MS office, Paradigm and in-house IT systems
Advanced skills in Relationship Management
Intermediate skills in Analytics
Competencies:
The successful candidate must demonstrate the following competencies:
Role Specific Behaviours
Ensures accountability.
Action oriented
Manages ambiguity.
Attracts top talent.
Business insight
Collaborates
Communicates effectively.
Manages complexity.
Manages conflict.
Courage
Customer focus
Decision quality
Develops talent
Values differences
Directs work.
Drives engagement
Financial acumen
Global perspective
Cultivates innovation.
Interpersonal savvy
Builds networks.
Nimble learning
Organizational savvy
Persuades
Plans and aligns.
Being resilient
Resourcefulness
Drives results
Demonstrates self-awareness.
Self-development
Situational adaptability
Balances stakeholders
Strategic mindset
Builds effective teams.
Tech savvy
Instils trust.
Drives vision and purpose
Optimizes work processes
Education and Experience:
The following requirements are essential:
Matric
MBBCH
2 years Clinical Experience
3 years Discovery Health medical advisor or related experience
1 year Stakeholder relationship management experience
Registered with relevant professional body
The following requirements will be advantageous:
Degree in Health Policy, Public health, Health Economics or Health Law and Bioethics
Knowledge of DH SOP's and Process experience (internal only)
Personal Attributes or Competency Profile
The Discovery Person
Values Driven
Optimistic
Learns on the Fly
Resilient
Instils Trust
People Savvy
Drives Results
Problem Solver
EMPLOYMENT EQUITY
The Company's approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.
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