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GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS)
 

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CLINICAL STAKEHOLDER SUPPORT SPECIALIST AT GOVERNMENT EMPLOYEES MEDICAL SCHEME
  • R Undisclosed
  • Permanent Specialist position
  • Menlyn
  • Job 2555675
 
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ABOUT THE POSITION
The position of Specialist: Clinical Stakeholder Support is vacant. The Specialist: Clinical Stakeholder Support will report directly to the Senior Manager: Clinical Advisory Services and forms part of the Healthcare Management division. The position is based at Head Office in Pretoria.
The total monthly remuneration package for this position is R 1 077 621 per annum, dependent on experience and skills.
 
The Specialist: Clinical Stakeholder Support will be required to provide support to the Senior Manager: Clinical Advisory Services through the implementation of the following Key Performance Areas (KPAs):
  • Contribute to conducting targeted research into local and international clinical guidelines and funding policies.
  • Critical review and analysis of current cost drivers and trends and compare with those of local and international sources for best practice.
  • Monitoring, analysis, and recommendations for clinical cost targets
  • Support in developing and maintaining adequate knowledge of data handling and interpretation of information translating interventions.
  • Support the Clinical Advisory Services Unit in the Scheme's product development and benefit design activities.
  • Perform Service Level Agreement quarterly site visits.
  • Support in the management and monitoring of SPNs to implement and give results within set targets.
  • Assist in improving member value.
  • Monitor project/programme in conjunction with the internal Project Management Unit of the Scheme.
  • Ensure that all relevant projects are carried out and finalised.
  • Liaise with GEMS SPNs on operational matters.
  • Represent the Healthcare Management Division at SPN and Stakeholder Engagements
  • Represent the Healthcare Management division in internal forums.
  • Support in the process for development and maintenance of Clinical Advisory Services standard operating procedures and policies.
  • Support the Clinical Advisory Services unit in providing clinical support to Healthcare Management and the Scheme's other divisions.
  • Support Provider Relations and Network engagements (quarterly hospital efficiency, provider society and groups and other forums as required).
  • Support in the clinical review of hospital and provider efficiency and network reports.
  • Support in the resolution of all complaints; Council of Medical Scheme, internal escalations, Provider Relations, and other complaints.
  • Support in Pathology & Radiology Benefit Management including, but not limited to, review of billing rules and tariff files.
  • Support in advising the Scheme on existing and new alternative reimbursement models.
  • Support in the review of Tariff and Billing rules.
  • Support in providing clinical advice and recommendations for the identified strategic sourcing interventions.
  • Support in the evaluation and analysis of proposals submitted to the Scheme and provide recommendations.
  • Assess and mitigate risk with the Clinical Advisory Services Unit.
  • Manage relationship building with key stakeholders.
  • Monitor and evaluate clinical cost targets.
 
Qualification requirements are:
  • Minimum four (4) year Diploma / Degree in Clinical Sciences or related fields.
  • Qualifications in Health Technology Assessment, or Evidence-Based Medicine, or clinical coding, or tariff and billing rules would be advantageous.
  • At least four (4) years of work experience in the healthcare funding / medical scheme industry.
  • At least two (4) years in the area of clinical coding and or tariff and billing rules.
  • Must have experience in the development and presentation of management reports.
  • A good understanding of coding (Nappi, Tariffs, ICD10, CPT4, UPFS and more).
  • A good understanding of the South African Healthcare Industry.
  • A good understanding of the Medical Schemes Act.
  • The ability to conduct research using a variety of academic and market-related resources.
  • Experience in the evaluation of health technology assessments would be advantageous.
 
Applications Closing date: Thursday, 22 February 2024 at 5PM.
 
Desired Skills:
  • Health Technology Assessment
  • Evidence-Based Medicine
  • clinical coding
  • billing rules
  • Tariffs
  • ICD10
  • CPT4
  • UPFS
Desired Qualification Level:
  • Diploma
 
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EXECUTIVE ASSISTANT (RISK MANAGEMENT AND COMPLIANCE) AT GOVERNMENT EMPLOYEES MEDICAL SCHEME
  • R Undisclosed
  • Permanent Intermediate position
  • Menlyn
  • Job 2556772
 
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ABOUT THE POSITION
The position of Executive Assistant Risk Management and Compliance is vacant. The Executive Asssitant Risk Management and Compliance will report directly to the Chief Compliance Officer and form part of the Risk Management and Compliance Division. The position is based at Head Office, Pretoria.
 
The total remuneration package per annum for this position is R448,243, dependent on experience and skills.
 
The Executive Assistant Risk Management and Compliance will be required to support the Chief Compliance Officer through the implementation of the following Key Performance Areas (KPAs):
  • Manage Executive calendar to ensure that all meetings are scheduled via Executive Assistant / agreed SOP.
  • Acts as a "gatekeeper" for the Executive's schedule.
  • Booking attendance of events, conferences and seminars both domestic and internationally.
  • Screening of incoming telephone calls and handle queries in an appropriate manner and engage with both internal and external customer queries.
  • Maintain and update the division's Annual Plan.
  • Ensure that all documentations are circulated and submitted as per the Year Planner e.g. Access the board portal on a regular basis to ensure compliance to action items and agenda inputs.
  • Prepare and circulate all divisional meeting documents e.g. agenda, action list, minutes, presentations etc.
  • Circulation for input and approval as well as submissions of documents for Board and Committee packs as per SOP's.
  • Preparation and collation of weekly, monthly and quarterly reports as required.
  • Circulate office communication as required by Executive.
  • Editing of memorandums, presentations and other documentation as required to ensure alignment to Corporate Identity (formatting, spelling etc).
  • Provides administrative support (e.g. minutes / notes / actions) in meetings.
  • Communication on behalf of the Executive to Service Providers if escalated by the Providers.
  • Coordinating the delivery of services provided by the Service Providers, including but not limited to scheduling; monitoring; evaluation of service delivery and payment.
  • Producing professional documents using MS Office.
  • Planning and tracking key business deliverables and reports through basic project management reporting.
  • Maintain and update the division's Annual Plan.
  • Ensure that all documentations are circulated and submitted as per the Year Planner e.g. Access the board portal on a regular basis to ensure compliance to action items and agenda inputs.
  • Prepare and circulate all divisional meeting documents e.g. agenda, action list, minutes, presentations etc.
  • Circulation for input and approval as well as submissions of documents for Board and Committee packs as per SOP's.
  • Preparation and collation of weekly, monthly and quarterly reports as required.
  • Circulate office communication as required by Executive.
  • Editing of memorandums, presentations and other documentation as required to ensure alignment to Corporate Identity (formatting, spelling etc).
  • Provides administrative support (e.g. minutes/notes/actions) in meetings.
  • Communication on behalf of the Executive to Service Providers if escalated by the Providers.
  • Coordinating the delivery of services provided by the Service Providers, including but not limited to scheduling; monitoring; evaluation of service delivery and payment.
  • Producing professional documents using MS Office.
  • Planning and tracking key business deliverables and reports through basic project management reporting.
 
Qualification requirements are:
  • Minimum two (2) year qualification in Administration or Secretarial Studies, or equivalent NQF Level 5.
  • A diploma/degree in Risk Management / Compliance or a related field will an added advantage.
  • At least 2 years' experience in an Executive / Personal Assistant role.
  • Experience within an Risk Management and Compliance environment would be advantageous.
  • Proficient in computer software such as Microsoft Office (Outlook, Word, Excel, and Power Point), Adobe Acrobat.
  • Experience with office administrative systems e.g. HR / Procurement Systems.
  • Excellent written English and the ability to communicate at all levels.
  • Respect the need for confidentiality and sensitive information.
  • To work under pressure to agreed deadlines and adapt to change.
  • Be organised and have good time management skills.
  • Attention to detail to ensure high quality work.
  • To work in a flexible manner including out of hours as and when required.
  • Have the ability to work well as part of a team.
  • Be responsible and reliable.
  • Self-Motivated and pro-active.
  • Attention to detail.
 
Desirable
  • Have an understanding of medical schemes industry.
  • Experience in the Healthcare Industry would be advantageous.
 
Applications Closing date: Thursday, 29 February 2024 at 5PM.
 
Desired Skills:
  • Executive / Personal Assistant
  • Risk Management
  • Compliance
Desired Qualification Level:
  • Diploma
 
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