The position of Specialist: Ambulatory Benefits Management is vacant. The Specialist: Ambulatory Benefits Management will report directly to the Manager: Ambulatory Benefits Management and forms part of the Healthcare Management. The position is based at GEMS Head Office.
The total remuneration package for this position is negotiable based on qualifications and experience.
The Specialist: Ambulatory Benefits Management will be required to provide support to the Manager: Ambulatory Benefits Management through the implementation of the following Key Performance Areas (KPAs):
- Assist and support the Manager: Ambulatory Benefits in executing all aspects of out-of-hospital Benefits management for the Scheme.
- The Specialist: Ambulatory Benefits Management will support the Scheme’s strategic objectives and mandates in developing and implementing of GEMS Clinical Risk Management Platform in relation to access to out-of-hospital benefits and utilisation management.
- The Specialist is required to provide support to the Manager for effective oversight of all managed care processes including:
All out-of-hospital aPMB authorisation processes
All PMB query management processes (prospective and retrospective).
Oversight of the Disease Management Programmes (DMPs)
Oversight of the Value-Based Care programmes
Oversight of all relevant inter-SPN integration processes.
Other projects as defined and aligned to Scheme Strategy
- Attend various Forums and contribute to effective strategic clinical and utilisation risk management.
- Support the accurate and timeous rollout of all defined programmes.
- Assist in developing and implementing a quality assurance and utilisation review programme for GEMS’ ambulatory benefits.
- Support the development, evaluation, and revision of SOPs in relation to out-of-hospital benefits and clinical risk management. Perform tasks timeously, accurately and with necessary detail in response to issues raised
- Qualification, skills and competencies requirements are
- Minimum of a 3-year Degree, Diploma or NQF Level 6 in Medical/Clinical Sciences Qualification (Nursing qualification advantageous)
- At least 4-6 years work experience in the Healthcare funding/Medical Schemes industry
- Solid Hospital Benefits and Disease Risk Management Operations experience with Medical Scheme operational insight
- Be analytical and can manage priorities
- Have excellent written and verbal communication and interpersonal skills • Critical thinking skills
- Ability to work independently under pressure and as part of a team
- Team player with good organisational skills
- Adaptable and resilient
- Project Management skills will be an added advantage
- Proficient with MS Office Suite
- Organised and have good time management skills
- Adaptable and resilient
- Self-motivated and pro-active (self-starter)
- Must be in possession of a valid driver’s license and be willing to travel at short notice
https://www.careerjunction.co.za/companies/35144/government-employees-medical-scheme
The closing date for applications is 09 June 2023. Should you not hear from us by 31 August2023, 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.
The position of ICT Integration Specialist is vacant. The ICT Integration Specialist will report directly to the Senior Manager: Application Development and forms part of the ICT division. The position is based at GEMS Head Office, Pretoria.
The total remuneration package will be will be based on qualifications and experience.
The ICT Integration Specialist will be required to participate in the planning, coordination, and solution development and implementation activities related to the integration of applications and technologies within the organizations application integration environment. Proven communication skills, problem-solving skills, proficiency in programming languages and data structures, and knowledge of integration best practices are critical to successful performance in this role and providing support to the SM: Applications Development through the following KPA’s:
Key Performance Areas (KPAs):
- Develop and maintain services used in application integrations.
- Design integration solutions and document the design in accordance with best practices.
- Work with development teams to architect, design, build, and implement application integrations.
- Develop and maintain data integration components such as SQL queries, stored procedures, data extraction and cleansing, and integration with system front end components.
- Write PL-SQL code to retrieve appropriate data as derived from requirements.
- Build reports and/or data extracts to support business analysis.
- Support development on resolving system defects, acting as liaison in developing solutions.
- Coordinate directly with business analyst to best understand and analyze application integration business specifications.
- Provide technical assistance to troubleshoot and resolve integration errors.
- Assist application software developers and engineers in development of Application Program Interface (APIs) to interact with the application integration environment
- Design, develop, and deploy solutions within the organization’s architectural principles, policies, and guidelines
- Continually develop skills in the integration technologies in place in the AI environment, as well as staying informed on new developments in integration technology.
- Implement audit, logging, and monitoring solutions to provide proactive operational support in the AI environment.
Qualification requirements are:
- National diploma or university degree in the field of computer science, information technology, information systems or relevant degree
- Application Integration Certification is must.
- Experience in Application Integration role is a must.
- Full systems development life cycle experience.
- Minimum of 8 years relevant work experience in Application Architect.
- Certification in Application Integration is a must.
- Systems Development Lifecycle Management is essential. Project Management is an advantage.
- Knowledge of HealthCare Solution is an advantage.
- Competency with XML constructs and schemas.
- Technically fluent in programming languages, including .Net environment/ platform
- Experience with business and technical requirements analysis, business process modeling/mapping and methodology development, and data mapping
- Confidence and experience with API protocols and schemas such as SOAP and REST
All external candidates, please apply via Career Junction using the following link :
https://www.careerjunction.co.za/companies/35144/government-employees-medical-scheme
The closing date for applications is 2 September 2022. Should you not hear from us by 30 November 2022 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.
*** Information is required for Employment Equity purposes.
*** 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.
*** Should you wish to have your information removed from the GEMS database, kindly send a request in writing to jobs@gems.gov.za.
***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.
The position of ICT Integration Specialist is vacant. The ICT Integration Specialist will report directly to the Senior Manager: Application Development and forms part of the ICT division. The position is based at GEMS Head Office, Pretoria.
The total remuneration package will be will be based on qualifications and experience.
The ICT Integration Specialist will be required to participate in the planning, coordination, and solution development and implementation activities related to the integration of applications and technologies within the organizations application integration environment. Proven communication skills, problem-solving skills, proficiency in programming languages and data structures, and knowledge of integration best practices are critical to successful performance in this role and providing support to the SM: Applications Development through the following KPA’s:
Key Performance Areas (KPAs):
- Develop and maintain services used in application integrations.
- Design integration solutions and document the design in accordance with best practices.
- Work with development teams to architect, design, build, and implement application integrations.
- Develop and maintain data integration components such as SQL queries, stored procedures, data extraction and cleansing, and integration with system front end components.
- Write PL-SQL code to retrieve appropriate data as derived from requirements.
- Build reports and/or data extracts to support business analysis.
- Support development on resolving system defects, acting as liaison in developing solutions.
- Coordinate directly with business analyst to best understand and analyze application integration business specifications.
- Provide technical assistance to troubleshoot and resolve integration errors.
- Assist application software developers and engineers in development of Application Program Interface (APIs) to interact with the application integration environment
- Design, develop, and deploy solutions within the organization’s architectural principles, policies, and guidelines
- Continually develop skills in the integration technologies in place in the AI environment, as well as staying informed on new developments in integration technology.
- Implement audit, logging, and monitoring solutions to provide proactive operational support in the AI environment.
Qualification requirements are:
- National diploma or university degree in the field of computer science, information technology, information systems or relevant degree
- Application Integration Certification is must.
- Experience in Application Integration role is a must.
- Full systems development life cycle experience.
- Minimum of 8 years relevant work experience in Application Architect.
- Certification in Application Integration is a must.
- Systems Development Lifecycle Management is essential. Project Management is an advantage.
- Knowledge of HealthCare Solution is an advantage.
- Competency with XML constructs and schemas.
- Technically fluent in programming languages, including .Net environment/ platform
- Experience with business and technical requirements analysis, business process modeling/mapping and methodology development, and data mapping
- Confidence and experience with API protocols and schemas such as SOAP and REST
All external candidates, please apply via Career Junction using the following link :
https://www.careerjunction.co.za/companies/35144/government-employees-medical-scheme
The closing date for applications is 2 September 2022. Should you not hear from us by 30 November 2022 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.
*** Information is required for Employment Equity purposes.
*** 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.
*** Should you wish to have your information removed from the GEMS database, kindly send a request in writing to jobs@gems.gov.za.
***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.
