Direct message the job poster from AfroCentric GroupTo provide an objective and transparent scientific basis for the allocation of limited healthcare resources through the development and maintenance of clinical funding protocols and case manager guidelines.
This is accompanied by provider and industry engagement, as well as guidance to client schemes and within business on the application of these protocols and guidelines.Experience & Qualification6 - 8 years clinical experience of which 2 years managed care experience advantageous, MBChBAccountabilitiesProvide clinical inputs on ex-gratia funding requestsOpen, review and resolve all clinical queries and assessments through providing a clinical decision or requesting more information where requiredImplement practical solutions that use the specialist and departmental systems and processesProvide specialist input and recommendations to improve the efficiency, compliance and quality objectives related to the area of specialisationIdentify problems and develop and propose solutions to present to appropriate leader or stakeholdersEnsure day to day operational support required from area of specialisation is provided to enhance performanceCost containment:Support the identification, development and implementation of cost-effective processes to increase efficiency and reduce cost drivers related to area of specialisationContinuously review cost / benefit and Return on Investment within area of specialisationEngage with providers and pre-authorisation agents to build informed and supportive mutual relationshipsMaintain a high level of impact on other departments to support improved deliveryContinually increase understanding of client and stakeholder needs, satisfaction and service deliveryKnowledge management:Assess all high risk or high-cost medical procedures to ensure appropriate authorisation and claiming is facilitatedProvide clinical training / support to identified stakeholdersProvide medical advisory services to relevant partiesEnsure that adequate knowledge regarding specialisation is shared as required and maintained within the research libraryProvide advice and / or training as requiredMaintain, develop and implement specialist knowledge within the day to day operations of the organisationBe a member of related professional bodiesEnsure CPD (continual professional development) or similar accreditation requirements are met annually to ensure maintained specialist accreditationNetwork key relationships:Engage with and provide support to the established network of internal and external expert resources and partnersSpecialist support to projects:Provide Specialist expertise and ensure best practice related to specialisation is implemented in projects, when requiredConform to project management disciplines when participating in projectsRepresent department or project on appropriate committees related to area of specialisationPosition Specific OutputsProvide expert orthopedic guidance and case assessments, particularly in consultations with treating providers.
Strong knowledge of neurosurgical practices and conditions related to orthopedic care.Evaluate patient cases to ensure alignment with funding and care policies.Communicate complex medical information clearly and effectively to internal teams and external stakeholders.Defend funding decisions in professional discussions, ensuring clarity and adherence to policies.
Exceptional verbal communication skills with the ability to articulate and defend medical decisions.Collaborate with clinical teams to enhance patient care strategies.Knowledge:Knowledge and application of relevant legislationKnowledge of device industryAbility to provide appropriate medical direction and advisory servicesKnowledge and application of clinical principles and processesKnowledge of clinical and funding protocol developmentClinical research and assessmentKnowledge of scheme rules and contractual negotiationsThe shortlisting process will only start once the application due date has been reached.
The time taken to complete this process will depend on how far you progress and the availability of line managers.Our Commitment to TransformationAfroCentric is committed to transformation and embracing diversity.
Our Employment Equity plan and targets will be considered as part of the recruitment process.
This commitment is what drives us to achieve a diverse workplace with employment equity as a key goal to create.Should you not receive feedback within a month after applying, consider your application unsuccessful!Seniority levelMid-Senior levelEmployment typeFull-timeJob functionHealth Care ProviderGovernment Administration
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