Discovery Health - Strategic Risk Management

Clinical Researcher (CCE Surgicals)

About Discovery

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 Strategic Risk Management

Strategic Risk Management (SRM) is a business-critical department in Discovery Health, holding the responsibility for ensuring sustainable and equitable management of scheme funds to deliver patient care. It houses multiple teams of experts in clinical, actuarial, and managerial roles all striving to gain the highest value for members who need care. SRM is a fast paced, highly visible and complex area of healthcare management with opportunities for executive visibility, external client engagement and innovation.

Key Purpose

The key purpose of this role is to apply the principles of Evidence-Based Medicine to develop, update, and maintain clinical funding policies — including protocols and baskets of care — while providing support by addressing all queries related to these policies. Additionally, the role offers clinical support to the business to ensure informed decision-making and effective healthcare management.

Areas of responsibility may include but not limited to

• Clinical policy development and support for internal business stakeholders.
• Identification of new areas, clinical conditions, and interventions where clinical policy support is required based on clinical need, healthcare improvement initiatives, new technologies, financial risk and any other risk management initiative.
• Undertaking of the design, development, implementation, training and monitoring effectiveness of new coverage decisions, clinical policies, protocols, baskets of care and formularies.
• Review and updating of existing coverage decisions, clinical policies, protocols, baskets of care and formularies.
• Communication, negotiation and liaison internally within Discovery Health
• Provide guidance to the business in terms of new and relevant clinical developments [e.g. new medicines, tests or technologies, legislation].
• Undertaking the design, development and maintenance of clinical content on DNA
• Undertaking of any other specific projects as delegated from time-to-time by management.
• Sound clinical and benefit knowledge to address day-to-day as well as policy issues relating to clinical queries emanating from coverage decisions, clinical protocols, baskets of care and formularies.
• Competent understanding of healthcare risk management.
• Thorough understanding of the medical schemes act, its regulations and amendments,
• Ability to navigate the Discovery intranet, authorization systems, claims payment systems, reporting tools and other relevant data systems
• Attend and represent the business unit and Discovery at conferences and presentations (during weekends and after hours as the need arises).

Personal Attributes and Skills

• Deciding and initiating action

• Adhering to Principles and Values
• Relationship building and networking
• Adaptability
• Problem solving
• Dealing with ambiguity and change
• Time Management
• Ensures Accountability
• Customer Centric
• Organisational Savvy
• Self-Development
• Stakeholder Management

Education and Experience

Education

• Matric
• Nursing degree or diploma or other clinical profession.
• Current SANC or other relevant registration.
• Training in Evidence Based Medicine; Training in Health Technology Assessment (advantageous)

Experience

• 3 or more years’ experience working as a Professional nurse or other clinical profession.
• At least 3 years’ experience in the medical scheme / managed care industry
• Experience in developing protocols, desk research, clinical policy, benefit designs.
• Experience in Discovery Health operations
• Experience handling negotiations with manufacturers, suppliers and providers;
• Knowledge of Medical Schemes Act and regulations

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.