Senior Specialist Clinical Policy

Position:
Senior Specialist Clinical Policy

Location:
Centurion, Gauteng

Position

Purpose:

The Senior Specialist:
Clinical Policy leads the development and governance of clinical policies and benefit criteria. The role ensures decisions are based on strong evidence, regulatory requirements, and managed care principles while supporting HTA integration, advising stakeholders, and mentoring junior policy staff.

• Postgraduate qualification in Public Health, Health Economics, Epidemiology, Clinical Research, or Health Policy (preferred).
• 3–5+ years’ experience in clinical policy, managed care, research, HTA, or clinical governance.
• Experience drafting/implementing clinical policies.
• Strong understanding of PMBs, HTA methods, benefit design, and coding systems.

Key Responsibilities

• Lead development, review, and lifecycle management of clinical policies and funding rules.
• Translate HTA findings into actionable policy recommendations.
• Ensure policy compliance with PMB legislation and regulatory standards.
• Oversee coding alignment (ICD‑10, CPT, ATC) for accurate claims adjudication.
• Present proposals to governance committees and facilitate multidisciplinary input.
• Provide expert clinical guidance to internal teams and external stakeholders.
• Mentor junior team members and ensure quality of policy outputs.
• Monitor policy impact, KPIs, appeals, and improvement opportunities.
• Strategic thinking, sound clinical judgement
• Strong communication and stakeholder engagement
• Analytical and evidence‑appraisal capability
• High attention to detail and scientific rigor
• Problem‑solving, resilience, and organisational savvy
• Ability to mentor and develop others

Note:
Company reserves the right to close the advert before specified closing date.

PHA has its head office in Westville, Kwa Zulu-Natal. It operates country-wide with a nationally linked network and uses a robust, flexible, as well as integrated system to ensure efficient and effective administration of membership and benefits.