The Strategic Managed Care (SMC) Medical Advisor is responsible for the clinical aspects of all work performed by the SMC unit. The purpose of the position is to plan, lead, organize and control the activities of the clinical department within the SMC unit to ensure that expert, evidence-based input and recommendations are made to MEDICAL SCHEME.
- Reporting Structure
The SMC Medical Advisor reports to the MEDICAL SCHEME SMC General Manager.
The Clinical Risk Analyst and Clinical Researcher positions report the SMC Medical Advisor.
The SMC Medical Advisor will work in collaboration with the Insight Actuaries within the SMC unit.
- Duties and responsibilities
- Provide clinical oversight on all aspects of work performed by the clinical department within the SMC unit.
- Provide mentorship within the SMC clinical team and lend support to meet deadlines.
- Review and assess new and existing clinical policies and protocols from an evidence-based, clinical and financial impact perspective.
- Perform research into funding decisions with the view of developing innovative reimbursement models and enhancing the appropriateness and cost-effectiveness of funding policies within the managed care environment
- In collaboration with the Insight actuaries, interpret healthcare utilisation patterns and trends with respect to the clinical appropriateness of care.
- Conduct reviews of good practice guidelines currently available to ensure that scheme funding decisions are based on best practice
- Evaluate current healthcare usage trends and compare with local and international sources for best practice.
- Monitor medical literature and use evidence-based principles to review and generate enhancements in funding protocols.
- Review and provide recommendations for reimbursement of new health technologies.
- Attend various Scheme forums and provide the expertise needed to give strategic input and clinical advisory services. Presentations will often be required.
- Provide clinical technical support when the Scheme requires expertise in defined areas.
- Participate in interdisciplinary committees and in clinical projects/studies within the Scheme as required.
- Provide input and support to the MEDICAL SCHEME SMC Expert Medical Advisory Board.
- Establish expert clinical committees, as required, to provide expertise to SMC in specialist areas of clinical practice.
- Provide input and support to the Universal Clinical Committee.
- Maintain relationships within the healthcare industry and stay abreast of new developments that impact the medical industry.
- Perform tasks timeously, accurately and with the necessary detail in response to issues raised.
- Experience and qualifications required
- An MBCHB is required.
- At least 5 years’ experience within the South African managed care environment is essential.
- At least 5 years’ managerial experience