Head : Medical Risk And Business Solutions

Head : Medical Risk and Business Solutions

MINIMUM JOB REQUIREMENTS

Qualifications

1. Bachelor's Degree in Health Sciences / Medical.
2. Post graduate qualification in Health sciences / Medical or related.
3. Post graduate qualification in Business Management or Administration will be an added advantage.
4. Registration with the HPCSA advantageous.

Experience

1. Relevant 10-12 years' experience in medical management and post settlement care of which 5 (five) years must have been on senior management level.

KEY PERFORMANCE AREAS

Strategy development and operational planning

1. Lead the Implementation of the Medical Risk and Business Solutions business strategy and plan that ensure alignment with short-term and long-term objectives.
2. Lead the implementation and annual review of the overall Strategic Plan for the department.
3. Oversee and implement specific key performance indicators and measures against outcomes detailed in the departmental strategic plans as set out by the Executive.
4. Provide strategic input into the plan of the current and future interventions necessary to achieve acceptable levels and standards of the RAF strategy and operational plans to the Executive forum.

Policy review and implementation

1. Provide direction on the development and implementation of policy, procedures and processes.
2. Work with appropriate structures to ensure effective execution of policy and practices.
3. Provide advice and guidance to the Policy department on legislative compliance, emerging issues, risks and the implementation of changes required on policy matters.

Medical management

1. Provide strategic direction in developing and managing medical management within operations including medical payments claims, medical assessments and post settlement care.
2. Lead and direct medical supply agreements, implement cost analysis strategies and negotiate with suppliers accordingly.
3. Maintain relationships with relevant stakeholders to flag problems and risks, and proactively shape any regulatory guidance.
4. Oversee the continuous improvement of medical claims processing.

Claims Actuarial Management

1. Oversee the alignment of allocated funds for the claims put forward to the RAF.
2. Lead and direct the claims actuarial analysis function.
3. Lead and direct the development of the co-developed "payout" models that will redesign compensation packages.

Research and Business Solutions

1. Provide strategic direction in the management of business solutions, inclusive of quality management and practice guidelines.
2. Analysis of medical management trends for RAF solutions and services.
3. Ensure the application and / or execution of standard practices.
4. Provide strategic direction in the analysis of research data.
5. Provide strategic direction and management of clinical support that is provided to the clinical research team responses to all clinically related queries of RAF external stakeholders.
6. Oversee trends, experience and approaches and provide recommendations.

Crash Prevention management

1. Provide strategic direction in developing and managing crash prevention strategies and road safety interventions.
2. Lead and direct strategic partnerships and interventions leading to mutually beneficial partnerships by means of strategic Memorandum of Understanding and agreement for the effective reduction in motor vehicle accidents.
3. Conduct research and implement analysis strategies to reduce the prevalence of motor vehicle accidents.
4. Maintain relationships with relevant stakeholders to highlight problems and risks, and proactively shape any regulatory guidance for the prevention of crash accidents through the reduction and awakening of road safety.
5. Oversee the continuous improvement of crash prevention interventions.
6. Promote and support the Road Accident Funds campaigns, including but not limited to road safety awareness which serves as a strategic initiative to drive down the incidence of Motor Vehicle Accidents.
7. Facilitate communication with all levels of stakeholder in relation to claims risk.
8. Ensure adequate representation of the Fund in relevant external activities and events i.e. medical institutions events.
9. Engage and inform medical institutions in changes of claims operations for both claimants and suppliers.

Financial Management

1. Provide strategic input into annual planning and budget development to support strategic operational goals.
2. Develop and implement RAF operational Claims Risk budget.
3. Ensure that the periodic financial and strategic goals of RAF as well as the performance expectations of the various teams within are achieved.
4. Responsible to report and review Claims Risk financial and non-financial goals.
5. Ensure sufficient internal control measures are implemented for adherence to PFMA, RAF and other relevant legislation and regulation.
6. Manage, monitor and control the department expenses budget.

People Management

1. Ensure the sourcing, development and retention of a high-performance team.
2. Ensure that recruitment of operational workforce is in line with employment equity targets.
3. Ensuring the motivation, cohesiveness, and alignment of the organization's team members.
4. Lead and manage staff in the department to ensure that they achieve their objectives in line with the strategic objectives of the RAF.
5. Oversee the implementation of human capital processes and procedures to control / regulate workplace conflict and / or institute corrective measures and consultation processes to address deviations from standards.
6. Allocate, direct, motivate and evaluate subordinates to help achieve their individual goals.

Reporting

1. Report quarterly on progress with implementation of operational plans.
2. Lead the development of functional reporting systems, for management, project or performance reporting.
3. Lead and direct the development of reports / policies / procedures and guide the process through the alignment of these documents to the overall RAF's Strategy.
4. Ensure regular and periodic reports are prepared and submitted as and when required to provide progress updates and / or inform management decisions.

Behavioural and Managerial Competencies Required

1. Strategic capability.
2. Results Orientation.
3. Business and financial acumen.
4. Compliance and Governance.
5. Leadership Agility.
6. Resilience.
7. Communication.
8. Working with people.
9. Network and Alliances.
10. Planning, Organizing, and Coordinating.
11. Employee Engagement.
12. Ethics and Values.
13. Client Service Orientation.
14. Coaching and Mentoring.
15. Change management.
16. Conflict Management.
17. Critical and Innovative Thinking.
18. Direction Setting.
19. Facilitating and Presentation Skills.
20. People Management.
21. Policy Conceptualisation and Formulation.
22. Programme / Project Management.
23. Service Delivery Innovation.
24. Stakeholder Development and Relations.
25. Reporting.

Understanding of the fundamental processes of business and the impact of the external / internal influences of clinical decision making.

Experience in the management of medical protocols and the development and maintenance of medical tariffs and codes.

Understanding actuarial models as it relates to claims management.

Knowledge of the marketplace and professional trade associations, key people and companies.

Strong analytical skills.

Ability to provide solutions to meet client needs and maximise value deliverables.

Understanding of the National health Policy framework and healthcare industry.

Knowledge on continuous improvement / innovation and optimization methodologies.

Seniority level: Executive

Employment type: Full-time

Job function: Health Care Provider and Management

Industries: Government Administration