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GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS)
 
 
 
SENIOR MANAGER: MEDICAL ADVISORY SERVICES
Type: Permanent 
Salary: The total remuneration package will be based on qualifications and experience. 
 
Closing date: 18 June 20224
 
APPLY
 
The position of Senior Manager: Medical Advisory Services is vacant. The Senior Manager: Medical Advisory Services will report directly to the Chief Healthcare Officer and form part of the Healthcare Management division. The position is based at Head Office, Pretoria.
 The total remuneration package will be based on qualifications and experience.

The Senior Manager: Medical Advisory Services will be required to support the Chief Healthcare Officer through the implementation of the following Key Performance Areas (KPAs): 
  • Assist the Chief Healthcare Officer in executing all clinical and medical advisory services within the Healthcare Management division and maintain clinical oversight on all aspects of the Scheme’s business.
  • Ensure that the execution of clinical and medical advisory services within GEMS are sound and in compliance with the Medical Schemes Act and Regulations and the Scheme Rules.
  • Conduct systemic reviews of evidence-based clinical practice guidelines and ensuring that Scheme funding decisions are based on best practice.
  • Manage the activities of the Scheme’s Expert Advisory Panels that assist in maintaining the Scheme's evidence-based clinical protocols.
  • Timeously review and make funding decisions and/or recommendations on the Scheme’s Ex Gratia ratification cases using evidence-based medicine.
  • Manage and maintain the Scheme’s Ex Gratia guidelines.
  • Provide clinical expertise and support to the Scheme’s Ex Gratia Committee and Sub-Committee.
  • Oversee the Scheme’s Maternity Programme and ensure strategic objectives are achieved.
  • Oversee the Pathology & Radiology Benefits Management, including, but not limited to, claims management and clinical review of billing rules and tariff files.
  • Establish new alternative re-imbursement arrangements (ARMs) and value-based reimbursement arrangements in maternity, pathology, radiology, and high-cost medicines/biologics.
  • Review and ensure CMS circulars are responded to and timeously implemented.
  • Review and provide written responses on the clinical aspects of all CMS complaints, appeals, and all other complaints timeously.
  • Attend and participate in various Scheme Forums and make valuable contributions by providing the expertise needed to provide strategic and clinical advisory services.
  • Provide clinical expertise and support to the Scheme’s Divisions, as well as business units within the Healthcare Management division.
  • Represent the Scheme and actively participate in all external stakeholder forums, conferences, etc.
  • Support the Scheme’s strategic objectives and mandates. This includes elements of innovation that are key to the Scheme’s objectives.
 
Qualification requirements are:
  • MBCHB as a minimum qualification. Must be registered with the Health Professions Council of South Africa (HPCSA).
  • Minimum 5 years of work experience in the medical aid/managed care industry.
  • Minimum 4 years as Manager / Senior Manager in the managed care/ medical aid industry.
  • Experience in Clinical and Financial Risk Management.
  • Benefit Design Experience.
  • Must be in possession of a valid driver’s license and own vehicle and be willing to travel at short notice.
  • A good understanding of all coding (Nappi, Tariffs, ICD10, CPT4, UPFS, and more).
  • The ability to conduct research using a variety of academic and market-related resources.
  • Essential skills:
    • Have a good understanding of GEMS Rules, Benefit Design, as well as administrative and managed care protocols;
    • Have a good understanding of the South African healthcare industry, the Medical Schemes Act, and other legislation;
    • Be organised and have good time management skills;
    • Be analytical and have the ability to manage priorities;
    • Have excellent written and verbal communication skills;
    • Have good interpersonal skills;
    • Have the ability to work well as part of a team;
    • Be computer literate on advanced levels;
    • Be responsible and reliable;
    • Have a diligent work ethic with attention to detail;
    • Be self-motivated and pro-active;
    • Have strong negotiation skills;
    • Work well under pressure.
 
​
Apply on Career Junction.
 
 The closing date for applications is  17 June 2024. 
 
Should you not hear from us by 31 August 2024, please consider your application unsuccessful. 
 
**** GEMS employs people with the highest level of integrity – submission to the appropriate pre-employment assessment is obligatory to be considered for the position.
*** Kindly note that the information provided on application of the position may be shared with a third party for vetting purposes and will be stored by GEMS for a period of 5 years.
*** Kindly note that information is required for Employment Equity Purposes and information gathered is strictly used according to the intended purpose of collection, unless there is a legal need or permission is granted from the applicant themselves to make use of it for other purpose
*** Should you wish to have your information removed from the GEMS database, kindly send a request in writing to jobs@gems.gov.za.

*** GEMS adopts a hybrid work model
*** GEMS is guided by the principles of employment equity. Preference will be given to groups who are underrepresented in accordance with GEMS employment equity plan.
*** Successful candidates will be required to seek approval to conduct other work outside of GEMS.
 
GEMS Employees are required to conduct themselves in a manner that reflects the organisation's paramount values: Excellence, Member Value, Integrity, Innovation, and Collaboration
 
 
 
 



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MANAGER EXTERNAL STAKEHOLDER SUPPORT
Type: Permanent
Salary: The total remuneration package will be based on qualifications and experience.
 
Closing date: 14 June
 
APPLY
 
The position of Manager External Stakeholder Support  is vacant. The Manager External Stakeholder Support will report directly to the Senior Manager Medical Advisory Services and form part of the Healthcare Management division . The position is based at Head Office in Pretoria.
The total remuneration package for this position negotiable based on qualifications and experience.
 
The Manager External Stakeholder Support will be required to assist and support the Senior Manager Medical Advisory Services through the implementation of the following Key Performance Areas (KPAs):
  • Manage the administrative function in the Medical Advisory Services business unit
  • Contribute to and conduct 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.
  • Assist in the management and monitoring of clinical cost targets
  • Assist in developing and maintaining adequate knowledge of data handling and interpretation of information translating interventions.
  • Chair and coordinate monthly SPN meetings
  • Perform Service Level Agreement quarterly site visits
  • Support in the management and monitoring of SPNs to implement and give results within set targets
  • Support in the management of divisional budget in line with budget allocation
  • 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 External Stakeholder Engagements, including but not limited to GEMS Provider Summits, industry conferences, member Makgotlas, SAPS, BHF, DPSA, various other external stakeholders
  • Represent the Healthcare Management in external stakeholder events
  • Assist in the process for development and maintenance of Medical Advisory Services standard operating procedures and policies.
  • Assist the Medical Advisory Services in providing clinical support to Healthcare Management and the Scheme’s other divisions in their external stakeholder-related matters
  • Support Provider Relations and Network engagements (quarterly hospital efficiency, provider society and groups and other forums as required).
  • Clinical review of hospital and provider efficiency and network reports.
  • Advise the Scheme on existing and new alternative reimbursement models received from external stakeholders
 
Qualification requirements are:
  • Minimum MBChB/ MBBCh. Must be registered with the HPCSA
  • Qualifications in Health Technology Assessment or Evidence-Based Medicine would be advantageous
  • At least five (5) years work experience in the healthcare funding / medical scheme industry with at least two (3) years at manager/supervisor level
  • Experience in the evaluation of health technology assessments would be advantageous
  • 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
 
Desirable:
  • Sound understanding of the medical schemes industry 
 
 
Apply on Career Junction.
 
The closing date for applications is  14 June 2024. Should you not hear from us by 30 August 2024, please consider your application unsuccessful. 
 
**** GEMS employs people with the highest level of integrity – submission to the appropriate pre-employment assessment is obligatory to be considered for the position.
*** Kindly note that the information provided on application of the position may be shared with a third party for vetting purposes and will be stored by GEMS for a period of 5 years.
*** Kindly note that information is required for Employment Equity Purposes and information gathered is strictly used according to the intended purpose of collection, unless there is a legal need or permission is granted from the applicant themselves to make use of it for other purpose
*** Should you wish to have your information removed from the GEMS database, kindly send a request in writing to jobs@gems.gov.za.

*** GEMS adopts a hybrid work model
*** GEMS is guided by the principles of employment equity. Preference will be given to groups who are underrepresented in accordance with GEMS employment equity plan.
*** Successful candidates will be required to seek approval to conduct other work outside of GEMS.
 
GEMS Employees are required to conduct themselves in a manner that reflects the organisation's paramount values: Excellence, Member Value, Integrity, Innovation, and Collaboration








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SPECIALIST CLINICAL HEALTH POLICY
Type: Permanent 
Salary: The total remuneration package will be based on qualifications and experience. 
 
Closing date: 14 June
 
APPLY
 
The position of Specialist Clinical Health Policy is vacant. The Specialist Clinical Health Policy will report directly to the Manager Clinical Health Policy and form part of the Healthcare Management division. The position is based at Head Office in Pretoria.
The total remuneration package for this position negotiable based on qualifications and experience.
 
The Specialist Clinical Health Policy will be required to assist and support the Manager Clinical Health Policy through the implementation of the following Key Performance Areas (KPAs):
  • Assist and contribute to the conduction of targeted research into local and international clinical guidelines and funding policies to ensure that Scheme funding decisions are based on best practice.
  • Assist in critically analysing clinical literature and use of evidence-based principles to review and generate enhancements in funding protocols to manage and monitor clinical cost targets.
  • Assist in the development and maintenance of adequate knowledge of data handling and interpretation of information translating interventions.
  • Assist in the review of the Scheme’s funding policies, protocols and formularies.
  • Assist in improving member value.
  • Assist in the process for development and maintenance of Medical Advisory Services standard operating procedures and policies.
  • Assist the Medical Advisory Services unit in providing clinical support to Healthcare Management and the Scheme’s other divisions.
  • Assist in providing clinical support to the Scheme’s Disease Risk Management Programmes and Maternity Benefit
  • Manage relationship building with key stakeholders.
  • 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 the process for development and maintenance of Medical Advisory Services standard operating procedures and policies.
 
Qualification requirements are:
  • Minimum 4-year Diploma / Degree in Medical Sciences or related fields
  • Qualifications in Health Technology Assessment or Evidence-Based Medicine would be advantageous
  • At least three (3) years of work experience in the healthcare funding / medical scheme industry
  • Previous experience in a Health Policy Unit will be advantageous.
  • Experience in the evaluation of health technology assessments would be advantageous.
  • Must have experience in the development and presentation for reporting purposes.
  • 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
 
Desirable:
  • Sound understanding of the medical schemes industry 
 
Apply on Career Junction.
 
The closing date for applications is  14 June 2024. Should you not hear from us by 30 August 2024, please consider your application unsuccessful. 
 
**** GEMS employs people with the highest level of integrity – submission to the appropriate pre-employment assessment is obligatory to be considered for the position.
*** Kindly note that the information provided on application of the position may be shared with a third party for vetting purposes and will be stored by GEMS for a period of 5 years.
*** Kindly note that information is required for Employment Equity Purposes and information gathered is strictly used according to the intended purpose of collection, unless there is a legal need or permission is granted from the applicant themselves to make use of it for other purpose
*** Should you wish to have your information removed from the GEMS database, kindly send a request in writing to jobs@gems.gov.za.

*** GEMS adopts a hybrid work model
*** GEMS is guided by the principles of employment equity. Preference will be given to groups who are underrepresented in accordance with GEMS employment equity plan.
*** Successful candidates will be required to seek approval to conduct other work outside of GEMS.
 
GEMS Employees are required to conduct themselves in a manner that reflects the organisation's paramount values: Excellence, Member Value, Integrity, Innovation, and Collaboration.