Head of Medical Advisors

Clinical Benefit Advisory Team

Head of Medical Advisors

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 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.
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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
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Competencies:

The successful candidate must demonstrate the following competencies:

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)

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.