Head of Oncology Risk Management and Care Coordination

Discovery Health

Head: Oncology Risk Management and Care Coordination

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. 

Key Purpose

We are seeking an experienced and innovative professional to lead the Population Health Management (PHM) strategy across oncology, end-of-life care, and complex multimorbidity. The successful candidate will be responsible for developing and executing strategies for comprehensive, end-to-end solutions for managing oncology risk and the risks associated with members living with complex, high-cost conditions. These solutions must address affordability constraints while improving health outcomes. The role requires a strong blend of leadership, strategic thinking, health system expertise, collaboration, data-driven decision-making, and stakeholder engagement.

Job Responsibilities

The successful applicant will be responsible for but not limited to the following job functions:

Strategic Leadership:

• Develop and implement a comprehensive evidence-based oncology risk management strategy that drives the provision of cost-effective care while improving health outcomes.  The strategy must span the needs of the full scheme population including screening and prevention, cost-effective treatment across the full episode of care (in and outpatient treatment and care), and appropriate care at end of life.  
• Design and oversee care coordination programmes for multi-morbid members with high healthcare utilization.
• Champion shared value (value-based care, alternative reimbursement models and guaranteed savings), quality measurement (including PROMS and PREMS), preventive health strategies, personalized care and innovative models
• Lead cross-functional collaboration across the business, including close collaboration with CCE, operations, risk intelligence and the health professional unit, in order to pull together different initiatives into a single coherent strategy that achieves the PHM objectives while aligning with broader organizational goals. 
• Provide thought leadership at industry level and across the Discovery business (e.g. Life, Vitality UK, Vitality SA, Ping An, Amplify Health) including providing support for the development of risk management strategies across the Discovery business.
• Present at leading conferences (e.g. Palliative Care conference, SA Society of Medical Oncologists, European Society of Medical Oncologists, ICON conference)

Data and Analytics

• Oversee the use of data analytics to identify trends, monitor risks and assess opportunities
• Analyse clinical and financial data to identify high-risk populations and cost-drivers
• Guide the development of dashboards and reporting tools to monitor health metrics and outcomes of initiatives
• Develop risk stratification frameworks and predictive models to guide interventions
• Guide data governance and sharing of data to empower stakeholders
• Direct Health Intelligence and Data Science Lab for the development of models that inform the design and guide the selection and initiation of appropriate interventions

R&D / product development / innovation

• Partner with the R&D team to enhance current benefit design and design new scheme benefits
• Enhance existing products (e.g. Personal Health Pathways, Health ID) to support the risk management strategy
• Develop new products for cancer care with R&D in Health and other business units
• Continually scan for, research and assess digital solutions and other innovations that support the risk management strategy and/or improve experience

Stakeholder Engagement

• Engage with clinical leaders, medical schemes, suppliers and regulatory entities.  This engagement will be at senior executive level (e.g. principal officers, CEOs and senior executives, leaders of medical societies, leading academics)
• Build partnerships to drive adoption of oncology and care coordination initiatives
• Ensure adherence by oncologists to clinical guidelines and value-based principles
• Represent Discovery Health in external forums and policy discussions and provide thought leadership at industry level
• Keep abreast with relevant legislation and ensure that all stakeholders understand implications

Contract Management

• Manage contracting strategy across oncology facilities (chemotherapy and radiation therapy) 
• Design and negotiate contract terms with corporate service providers 
• Ensure that all stakeholders adhere to contractual obligations and all administrative matters pertaining to contracts are completed
• Consult on legal matters pertaining to contract management

Implementation and Operational Oversight

• Senior SRM representative at the SRM/Ops oncology and care coordination forums
• Ensure that interventions are correctly implemented by relevant implementation and operational teams (including Functional Enablement, Discovery Care, Systems and Special Projects)
• Define KPIs and monitor performance of the operational teams against KPIs and ensure continuous improvement
• Oversee care coordination programmes for members with high resource requiring multi-morbidities (complex cases) including multidisciplinary case reviews, care planning and transititions of care
• Contract expert panels for multi-disciplinary review of oncology and complex cases
• Embed existing assets into solutions

Education, Knowledge and Work Experience

Education:

• Medical qualification or a related health field
• Post graduate qualification would be preferred (e.g. Master’s degree in Public Health, Health Economics, Health Policy, Health Administration, Population Health Management.
• Relevant healthcare professional body (e.g. HPCSA, SANC, SAPC)
• Certification/ qualifications in analytics, behavioural economics / science and disease management (advantageous).

Work Experience:

• Minimum 10+ years in managed care, clinical risk management or care coordination.
• Strong background in oncology risk management and complex case oversight.
• 3 -5 senior leadership experience.
• Proven track record of driving cross-collaboration design and implementation of health initiatives (advantageous).
• Good working knowledge of health analytics, clinical coding and reimbursement models (advantageous).
• Stakeholder management at senior executive level and communication skills (advantageous).

Knowledge:

• Strategic planning and execution
• Data literacy and familiarity with health informatics
• Strong communication and stakeholder management
• Change management and innovation leadership
• Understanding of healthcare systems, policy and reimbursement models
• Managing multidisciplinary teams
• Public speaking / presentations
• Publication of research

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.