An exciting position has become available at our Head Office in Cape Town. Suitably qualified applicants who possess the requirements listed below are encouraged to apply. SAMWUMED is committed to transformation in Southern Africa.
PURPOSE OF THE JOB
Accountable for the overall clinical and managed care functions/initiatives/interventions of the Scheme. Provide medical and scientific expertise in the development of the clinical/managed care strategic and tactical plans for the Scheme’s healthcare risk management strategy.
To ensure the execution of deliverables to limit the Scheme’s overall risk exposure, while promoting good governance and sound financial and business principles.
KEY PERFORMANCE AREAS WILL INCLUDE, BUT NOT LIMITED TO:
- Develop and manage the Clinical Risk strategy in alignment with the overall Scheme’s strategy.
- Provide strategic input when reviewing proposals for benefit design/enhancements and operational protocols for accessing healthcare.
- Provide clinical input into the managed healthcare business strategy.
- Identify, evaluate, secure and manage high potential clinical opportunities and initiatives to increase Scheme visibility and relevance.
- Manage key and/or special clinical projects and proposals.
- Perform underwriting function on behalf of the Scheme in line with CMS requirements.
- Collaboration with key clinical/managed care stakeholders to support Scheme business strategy.
- A key contributor in meetings and may occasionally supervise junior staff.
- Develop Clinical risk register to mitigation plans to limit risks.
- Ensure and monitor regulatory and legal compliance and governance against set clinical guidelines and principles
QUALIFICATIONS, EXPERIENCE AND SKILLS
- Bachelor of Medicine and Surgery (MBChB) Degree.
- Masters in Business Administration (MBA) will be preferable.
- 5 years’ experience in related role within the pharmaceutical or healthcare industry.
- Experience at a Senior Management or Executive level in Managed care, Clinical Advisory Services and Clinical Governance in Health Insurance or the Medical Aid Scheme industry.
- Experience in a Commercial or Operational leadership role, preferably in the digital health, technology, or service sector.
- Medical doctor experience.
- In depth understanding of managed healthcare backed by clinical experience.
- Strong understanding of therapeutic areas relevant to the role.
- Proven experience in managing clinical projects from conception to completion.
- Thorough knowledge and understanding of the Medical Scheme’s Act No. 131 of 1998 and the relevant PMB legislation.
- Research expertise, i.e., design and evaluate clinical studies and trials will be an advantage.
COMPETENCIES
- Excellent Communication both written and verbal.
- Excellent interpersonal skills including high ethical standards.
- Self-starter and takes initiative.
- Strategic thinker and detailed orientated.
- Being flexible, agile and resilient.
- Aptitude in decision-marking and problem-solving.
- Accountable, responsible and ownership approach.
- Organised and attentive to detail.
- Clinical complaints management skills.
- Strong network or managing or building relationships skills.
- Advance knowledge of medical databases and statistical software (e.g. SPSS, SAS) will be an advantage.
- Knowledge of and experience with risk management software.
Persons interested in applying for the above position are requested to forward a comprehensive CV to recruitment@samwumed.org. Persons with disabilities are encouraged to apply.
The Closing date for applications is Tuesday, 6 May 2025
Disclaimer: Your personal data submitted will be dealt with on a strictly confidential and discreet basis and processed in relation to this job application and will be stored and processed securely in accordance with our data information policy and procedures. By submitting an application, you agree to your data being used, stored and processed for the purpose of recruitment
