To ensure that the scheme or organisation is protected from over-utilisation or inappropriate claiming by service providers that leads to abuse of member and scheme funds Accountabilities Continuous improvement: Provide clinical inputs on ex-gratia funding requests -Open, review and resolve all clinical queries and assessments through providing a clinical decision or requesting more information where required -Implement practical solutions that use the specialist and departmental systems and processes -Provide specialist input and recommendations to improve the efficiency, compliance and quality objectives related to the area of specialisation -Identify problems and develop and propose solutions to present to appropriate leader or stakeholders -Ensure day to day operational support required from area of specialisation is provided to enhance performance Cost containment: -Support the identification, development and implementation of cost-effective processes to increase efficiency and reduce cost drivers related to area of specialisation -Continuously review cost / benefit and Return on Investment within area of specialisation Drive customer-centricity: -Engage with providers and pre-authorisation agents to build informed and supportive mutual relationships -Maintain a high level of impact on other departments to support improved delivery -Continually increase understanding of client and stakeholder needs, satisfaction and service delivery Knowledge management: -Assess all high risk or high-cost medical procedures to ensure appropriate authorisation and claiming is facilitated -Provide clinical training / support to identified stakeholders -Provide medical advisory services to relevant parties -Ensure that adequate knowledge regarding specialisation is shared as required and maintained within the research library -Provide advice and / or training as required -Maintain, develop and implement specialist knowledge within the day-to-day operations of the organisation Maintain expertise level: -Be a member of related professional bodies -Ensure CPD (continual professional development) or similar accreditation requirements are met annually to ensure maintained specialist accreditation Network key relationships: -Engage with and provide support to the established network of internal and external expert resources and partners Specialist support to projects: -Provide Specialist expertise and ensure best practice related to specialisation is implemented in projects, when required -Conform to project management disciplines when participating in projects -Represent department or project on appropriate committees related to area of specialisation Competency Requirements Attribute: -Entrepreneurship -Influence -Collaboration -Credibility -Ownership Knowledge: -Knowledge and application of relevant legislation -Knowledge of device industry -Ability to provide appropriate medical direction and advisory services -Knowledge and application of clinical principles and processes -Knowledge of clinical and funding protocol development -Clinical research and assessment -Knowledge of scheme rules and contractual negotiations Skill: -Analytical skills -Business Writing Skills -Communication Skills -Computer Technology Skills -Attention to Accuracy and Detail -Problem solving and decision-making skills -Numerical Ability -Customer Focus Experience 6 - 8 years Managed Care experience preferred Qualifications Bachelor of Health Sciences in Medical Orthotics and Prosthesis. Professional Membership Candidate must be registered and active as such with HPCSA Competitive
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