Clinical Researcher - Sandton
DISCOVERY LTD
Clinical Researcher Business Unit: Discovery Health Function: Clinical Date: 12 Mar 2024 Discovery - Health Clinical Researcher About Discovery Discovery's core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society. About the Strategic Risk Management team As a member of the Strategic Risk Management (SRM) you are responsible for risk management and the relationship interface with all Health Professional disciplines. The unit plays a key role in defining and implementing benefit changes and innovative initiatives to achieve agreed strategic company objectives. Key Purpose To use the principles of Evidence-Based Medicine to develop, update/maintain and input into clinical funding policies (protocols, baskets of care, etc). Address all queries related to clinical funding policies/protocols. Provide clinical support to the business. Areas of responsibility may include but not limited to Clinical policy development and support for internal business stakeholders. Identification of new areas, clinical conditions, and interventions where clinical policy support is required based on clinical need, healthcare improvement initiatives, new technologies, financial risk, and any other risk management initiative. Undertaking of the design, development, implementation, training and monitoring effectiveness of new coverage decisions, clinical policies, protocols, baskets of care and formularies. Review and updating of existing coverage decisions, clinical policies, protocols, baskets of care and formularies. Communication, negotiation, and liaison internally within Discovery Health as well as externally with manufacturers, suppliers, healthcare providers, and other stakeholders including various industry forums as may be mandated. Ability to engage with health professionals and providers involved in the clinical care of members, on an individual case by case basis or policy related matters. Provide guidance to the business in terms of new and relevant clinical developments [e.g., new medicines, tests or technologies, legislation]. Undertaking the design, development, and maintenance of clinical content on DNA. Undertaking of any other specific projects as delegated from time-to-time by management. Sound clinical and benefit knowledge to address day-to-day as well as policy issues relating to clinical queries emanating from coverage decisions, clinical protocols, baskets of care and formularies. Competent understanding of healthcare risk management. Thorough understanding of the medical schemes act, its regulations, and amendments. Ability to navigate the Discovery intranet, authorization systems, claims payment systems, reporting tools and other relevant data systems. Preparation of responses related to media queries where clinical matters are concerned. Attend and represent the business unit and Discovery at conferences and presentations (during weekends and after hours as the need arises). Personal Attributes and Skills Values Driven Optimistic Learns on the Fly Resilient Instils Trust People Savvy Drives Results Problem Solver Inspirational leaders who live the values and believes in the core purpose. Humble Treat others with care, dignity, and respect Ensure that the business case prevails. Have a bias for action. understand that people are Discovery's greatest asset. build an environment for optimal performance. set ambitious goals and implement the highest standards. Students and Master of Communication. Never stop learning. Have and express strong beliefs and views yet are open-minded and support the chosen path. Education; Knowledge and Experience The following are essential requirements: Nursing degree/diploma or other clinical profession Current SANC or other relevant registration 5 or more years' experience working as a Professional nurse or other clinical profession. At least 5 years' experience in the medical scheme/managed care industry. Technical skills and knowledge: Advanced Computer literacy Intermediate Healthcare risk management knowledge Intermediate negotiations skill with manufacturers, suppliers, and providers. (advantageous) Advanced Medical Schemes Act and regulations knowledge. (advantageous) The following are advantageous requirements: Training in Evidence Based Medicine. Training in Health Technology Assessment. Experience in developing protocols, desk research, clinical policy, benefit designs. Experience in Discovery Health operations EMPLOYMENT EQUITY The Company's approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.
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