Quality And Process Specialist - Managed Care

Minimum requirements:A bachelor's degree or diploma in a relevant field such as Administration, Business Management, Quality Management, or a related discipline.Minimum of 3-5 years of experience in quality assurance, process improvement, or a related field. Direct experience in the medical aid industry is highly desirableKnowledge of Legislation relating to the work of medical schemes:Scheme RulesBasic medical terminology and medical procedures and operationsInternal systems and processes within CAMAFPrescribed Minimum BenefitsChronic Diseases ListBenefit optionsSouth African Medical AssociationManaged HealthcarePreferred Provider Network etc.Responsibilities:Responsible for overseeing and improving the quality and efficiency of managed care operationsAnalysing current processes, developing strategies for improvement, and ensuring compliance with industry standardsWork closely with various departments to implement best practices and enhance service deliveryMonitor and evaluate the effectiveness of current processes and identify areas for improvementConduct regular assessments to ensure compliance with industry standards and regulationsAnalyse existing workflows and processes to identify inefficienciesDesign and implement process improvements to streamline operations and improve service delivery and outcomesCollaborate with cross-functional teams to ensure seamless integration of new processesPrepare comprehensive reports for team leaders and management, highlighting key findings and recommendationsUtilize data to drive decision-making and strategic planningProvide training and support to staff on quality improvement initiatives and new processesDevelop educational materials and plan workshops to promote best practicesFoster a culture of continuous improvement and excellence within Managed careAddress and resolve any issues or concerns related to managed care quality and processesMonitor member and provider satisfaction levels