Key Performance Areas (KPAs): ü Manage the administrative function in the Medical Advisory Services business unitü Contribute to and conduct targeted research into local and international clinical guidelines and fundingpolicies.ü Critical review and analysis of current cost drivers, and trends and compare with those of local andinternational sources for best practice.ü Assist in the management and monitoring of clinical cost targetsü Assist in developing and maintaining adequate knowledge of data handling and interpretation of informationtranslating interventions.ü Support the Medical Advisory Services Unit in the Schemes product development and benefit design activitiesü Chair and coordinate monthly SPN meetingsü Perform Service Level Agreement quarterly site visitsü Support in the management and monitoring of SPNs to implement and give results within set targetsü Support in the management of the divisional budget in line with budget allocationü Assist in improving member valueü Monitor project/programme in conjunction with the internal Project Management Unit of the Schemeü Ensure that all relevant projects are carried out and finalisedü Liaise with SPNs on operational mattersü Represent the Healthcare Management Division at SPN and Stakeholder Engagementsü Represent the Healthcare Management division in internal forumsü Assist in the process for development and maintenance of Medical Advisory Services standard operatingprocedures and policies.ü Provide clinical oversight and support to the Schemes internal processes, and support to the Schemesother divisions in functions such as claims risk management, complaints process, health and wellnesscampaigns, and outgoing Scheme communicationü Assist in the resolution of all complaints; Council of Medical Scheme, internal escalations, Provider Relations,and other complaintsü Assist in the review of Competition Commission submissionsü Pathology & Radiology Benefit Management including, but not limited to, review of billing rules and tariff filesü Advise the Scheme on existing and new alternative reimbursement modelsü Provide clinical support in the review of Tariff and Billing rulesü Provide clinical support in the management of the Schemes ambulatory, hospital and medicine benefitsü Evaluation and analysis of proposals submitted to the Scheme and provide recommendations, including,ü but not limited to: analysis of proposed appliances reimbursement, ARMS and value-based care models.ü Provide clinical advice and recommendations for the identified strategic sourcing interventionsRequirements ü Minimum MBChB/ MBBCh. Must be registered with the HPCSAü Qualifications in Health Technology Assessment or Evidence-Based Medicine would be advantageousü At least five (5) years work experience in the healthcare funding / medical scheme industry with at least two(2) years at manager/supervisor levelü Experience in the evaluation of health technology assessments would be advantageousü Must have experience in the development and presentation of management reportsü A good understanding of coding (Nappi, Tariffs, ICD10, CPT4, UPFS and more)ü A good understanding of the South African Healthcare Industryü A good understanding of the Medical Schemes Actü The ability to conduct research using a variety of academic and market-related resources Desirable ü Sound understanding of the medical schemes industry