Senior Manager: Clinical Policy & Governance

Momentum Health; Centurion; On-site; ZAR 800 000 - 1 100 000; Full time

Job summary

A South African health organization is seeking a senior specialist to lead the Clinical Policy and Governance function. The ideal candidate will have a medical background, an MBA, and at least 5 years of experience in a leadership role within a health insurance or managed care environment. Responsibilities include designing clinical policies, overseeing health technology assessments, and ensuring compliance with regulations. This position fosters collaboration across various teams to support informed decision-making and strategic initiatives.

Qualifications

• Registration with the Health Professions Council of South Africa (HPCSA).
• Minimum of 3 to 5 years’ experience in a people management or senior specialist leadership role.
• Proven experience in clinical research and health technology assessment.

Responsibilities

• Lead the design and implementation of clinical policies and protocols.
• Oversee the Health Technology Assessment (HTA) process.
• Engage with stakeholders to determine HTA outcomes.

Skills

Clinical Risk Management

Leadership

Critical thinking

Business acumen

Medical terminology

Education

Bachelor of Medicine or Bachelor of Surgery

Masters of Business Administration (MBA)

Job description

Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members

Disclaimer

As an applicant, please verify the legitimacy of this job advert on our company career page

Role Purpose

Provide senior specialist leadership for the Clinical Policy and Governance function within Health Risk Management by ensuring robust, evidence-based clinical policy, regulatory interpretation, and coding standards. The role is responsible for guiding health technology assessment, PMB and statutory interpretation, and clinical coding frameworks to inform benefit design, risk management, and strategic decision-making

Requirements

• Bachelor of Medicine or Bachelor of Surgery.
• Masters of Business Administration (MBA).
• Clinical Risk Management.
• Registation with the Health Professions Council of South Africa (HPCSA).
• Medical terminology, principles, processes and practices.
• South African legislation with regards to Medicine/Healthcare.
• Healthcare and clinical standards and best practices.
• Knowledge of the insurance industry.
• Relevant clinical and insurance legislation.
• Minimum of 3 to 5 years’ experience in a people management or senior specialist leadership role, with demonstrated accountability for team leadership and delivery.
• Proven experience in clinical research, evidence appraisal, and health technology assessment, including translation of clinical evidence into policies or funding recommendations.
• At least 5 years’ experience within a medical scheme administrator, managed care, or health insurance environment, with exposure to PMB interpretation, benefit design, and regulatory requirements.

Duties & Responsibilities

• Lead the design, implementation, and continuous improvement of clinical policies and protocols in alignment with statutory, regulatory, and business requirements.
• Oversee the end-to-end Health Technology Assessment (HTA) process to inform benefit design, policy updates, and clinical funding criteria.
• Engage with pharmaceutical, device, and clinical stakeholders to determine HTA outcomes and inform evidence-based policy positions.
• Ensure policies and decisions are compliant with CMS regulations, Scheme Rules, and relevant managed care legislation.
• Oversee clinical coding governance to ensure coding accuracy, alignment to benefit rules, and data integrity.
• Establish policy frameworks that guide consistent interpretation and application across internal business units and external stakeholders.
• Identify and assess emerging technologies and clinical trends to inform proactive policy and funding recommendations.
• Collaborate with internal governance committees and expert panels to support sound, transparent decision-making.
• Maintain external representation and benchmarking through professional bodies, HTA societies, and industry forums.
• Build and sustain collaborative relationships with key internal and external stakeholders, including product, operations, legal, and actuarial teams.
• Represent the organization in strategic engagements with pharmaceutical and medical device companies to assess new technologies, value propositions, within HRM mandate.
• Partner with clinical networks to promote consistency in clinical governance and managed care practices.
• Support business development and client engagement initiatives through expert clinical insights and evidence-based recommendations.
• Deliver thought leadership on policy trends, HTA methodologies, and clinical governance principles to business and industry audiences.
• Lead a multidisciplinary team comprising HTA specialists, clinical policy researchers, and clinical coding professionals.
• Foster a high-performance, learning-oriented culture that encourages innovation, accountability, and collaboration.
• Provide leadership, coaching, and professional development to strengthen technical and leadership capabilities within the team.
• Manage performance, ensuring alignment to strategic objectives and measurable business impact.
• Uphold Momentum’s values and drive an inclusive, respectful, and purpose-driven work culture.

Competencies

• Business improvement.
• Strategy implementation.
• Business acumen.
• Leadership.
• Critical thinking.