A well-established company is recruiting for aMANAGER CLINICAL SERVICESCENTURIONPurpose Of The PositionTo provide support to the Clinical & Operations Executive in implementing the Scheme's strategy in a manner that supports healthcare quality and best practice standards.Essential RequirementsB degree/Higher Diploma in Health Sciences OR equivalent combination of education and job-related experience (NQF Level 7)Registration with Health Professions Councils of South Africa (HPCSA) OR South African Nursing Council is essentialMinimum of 5-7 years' experience in Clinical Services of which 3 years must be in Medical Scheme/ Healthcare Funding industryKey Result Areas (KRAs) And ResponsibilitiesStrategy ImplementationCollaborate with the Clinical & Operations Executive to identify key performance indicators (KPIs) for the implementation of the Scheme's strategy for clinical operationsCreate and implement a clinical operational plan to support implementation of Scheme's strategyClinical OperationsAssist in monitoring the performance of service providers against agreed upon service level agreements (SLAs)Assist in developing plans to mitigate against negative member impact, where service failures have been identifiedIdentify and escalate identified unresolved service issues to managementAssist in the establishment and maintenance of Standard Operating Procedures (SOPs), policies, and guidelines relating to the Clinical UnitMonitor adherence to SOPs, policies, and guidelines and report deviations to managementAnalyse and recognise trends in data to plan future projects and monitor the daily operationsProduct Development and Benefit DesignPerform project management functionAssess and monitor programme outcomesSupport and coordinate benefit design activitiesImplement and monitor the tariffs and reimbursement arrangementsAssist and enable research into innovative product development and enhancementStakeholder ManagementCoordinate monthly and ad hoc service provider meetingsParticipate in the Scheme's various operational ForumsEnsure that all escalated queries are resolved timeouslyInvestigate and provide high-level input into the resolution of escalated queries from members and healthcare service providersInvestigate and provide high-level input into the resolution of escalated queries from Council of Medical Schemes (CMS)Coordinate and provide interdepartmental clinical supportReportingReview operational reports to identify cost drivers in the scheme's healthcare expensesIdentify trends and provide early warning reports to managementIdentify and escalate any concerns emanating from the reviewed reportsReview clinical framework audit reports to ensure alignment with the clinical governance policyBudgeting and Financial ManagementProvide input into the Clinical Unit's budgetManage expenditure within the budgetGovernance, Risk and Compliance (GRC)Ensure adherence to internal policies, SOPs and legislative requirementsIdentify, assess, and mitigate risksProvide input into the operational risk registerPlease send your CV and supporting documents to (Email Address Removed).If you have not received any feedback within 2 weeks, please assume that your application was not successful.Desired SkillsCLINICAL SERVICES
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