Position Purpose
To assist in the development of funding rules, interact with internal and external stakeholders on funding issues, provide clinical support to existing and new managed care programs, ensure consistent application of clinical funding rules for individual schemes, balance risk management interventions with operational efficiencies and member-centricity, support clinical governance and management functions, and assist with data analysis and other duties as assigned.
Experience
8 years of health policy; medical, research experience, and healthcare industry experience. Preferable: formal training in the review of evidence-based medicine, particularly in the field of health technology assessment; managed care experience; English writing (e.g., journalism, editing).
Qualifications
Minimum qualification is a B Pharm degree. Valid registration with the South African Pharmacy Council.
Accountabilities
Continuous improvement:
Assist with escalated queries that refer to Medical Health policies.
Complete required Medical Health policy administration as defined to standard and within deadlines.
Conduct research on Medical Health policy area of specialization including medical devices and drugs and develop policies for review and sign-off.
Communicate and liaise with identified industries.
Assist with policy implementations.
Provide medical advisory services to relevant parties.
Support new product development.
Assist with medical and legal defense of clinical policies.
Implement practical solutions that use the specialist and departmental systems and processes.
Provide specialist input and recommendations to improve the efficiency, compliance, and quality objectives related to the area of specialization.
Identify problems and develop and propose solutions to present to appropriate leader or stakeholders.
Ensure day-to-day operational support required from area of specialization is provided to enhance performance.
Cost containment:
Support the identification, development, and implementation of cost-effective processes to increase efficiency and reduce cost drivers related to area of specialization.
Continuously review cost/benefit and Return on Investment within area of specialization.
Drive customer-centricity:
Maintain a high level of impact on other departments to support improved delivery.
Continually increase understanding of client and stakeholder needs, satisfaction, and service delivery.
Knowledge management:
Ensure that adequate knowledge regarding specialization is shared as required and maintained within the research library.
Provide advice and/or training as required.
Maintain, develop, and implement specialist knowledge within the day-to-day operations of the organization.
Maintain expertise level:
Be a member of related professional bodies.
Ensure CPD (continual professional development) or similar accreditation requirements are met annually to ensure maintained specialist accreditation.
Network key relationships:
Engage with and provide support to the established network of internal and external expert resources and partners.
Specialist support to projects:
Provide specialist expertise and ensure best practice related to specialization is implemented in projects, when required.
Conform to project management disciplines when participating in projects.
Represent department or project on appropriate committees related to area of specialization.
Position Specific Outputs:
Policy development inclusive of Health Technology Assessment documentation compilation; Medicine management policy for publication on the web; Reimbursement outcome correspondence to pharmaceutical industry applicant.
Presentation and defense of reimbursement policy recommendations to scheme independent clinical advisory panels, clinical societies, pharmaceutical industry, and scheme principal officers.
Regular engagement on market access issues (including negotiation on pricing) with the pharmaceutical industry market access teams.
Medicine list development and review, including engagement with internal and external stakeholders.
Medicine information services on escalated cases which include clinical and legislative support.
Clinical and strategic input within area of specialization on queries from internal and external stakeholders.
Training of new staff and ongoing internal support.
Thought leadership.
Provision of subject matter expertise for internal and external clinical governance issues.
Internal reporting and record keeping.
Competency Requirements:
Attribute:
Influence
Collaboration
Ownership
Credibility
Entrepreneurship
Knowledge:
Knowledge and application of relevant legislation.
Knowledge and understanding of statistical and financial tools.
Knowledge and understanding of scheme rules and products.
Skill:
Adobe Creative Suite.
Data modeling and evaluation.
Problem solving and decision making skills.
Computer Technology Skills.
Task Management.
Business Forecasting and Modeling.
Ability to Guide, Direct Policy development and implementation.
Business Writing Skills.
Communication Skills.
Attention to Accuracy and Detail.
Customer Focus.
Numerical Ability.
#J-18808-Ljbffr
