Job title : Senior Manager: Healthcare Networks and Provider RelationsJob Location : Gauteng, PretoriaDeadline : January 30, 2025Quick Recommended Links Jobs by Location Job by industries Duties & Responsibilities The Senior Manager: Healthcare Networks and Provider Relations will be required to support the Chief Healthcare Officer through the implementation of the following Key Performance Areas (KPAs): Support the CHO in the oversight and execution of all activities related to the management of the Scheme's healthcare networks: Primary Healthcare Networks Specialist Networks Renal Dialysis Network Hospital Networks Pharmacy Network Manage all healthcare network to ensure compliance, quality and cost efficiencies are maintained in line in line with contractual agreements. Manage the Scheme's Network Provider Upskilling and Training programme and budget in line with Scheme policy. Oversee the management of- and support other scheme divisions in their provider relations and network management activities. Support the CHO in the oversight and execution of all activities related to: The Scheme's Healthcare Provider Relations; and The Scheme's Provider Liaison Officer (PLO) Programme. Proactively engage and maintain sound relationships with identified healthcare provider groups (hospital groups, pathologist groups, primary care practitioner societies, specialist societies, pharmacy groups, and other providers) on relevant strategic matters. Participate in various stakeholder engagements (symposiums, summits, conferences, round tables, etc.)
as delegated by the Chief Healthcare Officer. Manage the Scheme's provider relations and sponsorship budget in line with Scheme policy. Oversee all activities related to the Scheme's Provider Relations Officer (PLO) Programme. Implement and manage the rollout of the Scheme's PLO function across all the country's regions. Establish sound mechanisms to enhance and integrate provider relations and network management services. Support the CHO in the implementation of the Scheme's strategic initiatives. Continuously monitor the healthcare landscape and implementing innovative initiatives to improve member value. Manage the end-to-end process of designing, planning, implementing, and maintaining comprehensive standard operating procedures and policies. Perform program and project management functions for the Healthcare Management Division, including developing, implementing, and monitoring strategic and operational work plans. Ensure that all Scheme's functions align with the Medical Schemes Act, Scheme Rules, and other Legislation. Desired Experience & Qualification Qualification requirements are: At least a 3-year diploma or degree in Clinical Sciences (medical/ nursing/ physiotherapy/psychology, etc.)
and other relevant/ equivalent qualifications. Minimum 7 years of work experience in the healthcare funding/ medical scheme industry. Minimum 5 years as Manager/Supervisor in the healthcare funding/ medical scheme industry. Must have experience in provider network and relationship management. Must have a good understanding of the Medical Schemes Act. Must have excellent computer literacy and Microsoft Office skills. Must be able to analyse qualitative and quantitative data. Must have excellent communication and writing skills. Must have planning and project management skills. Must be able to pay attention to detail and be a self-starter. Must have the ability to work well as part of a team. Must have a valid driver's license, own a vehicle, and be willing to travel at short notice. Must understand all healthcare coding (Nappi, Tariffs, ICD10, CPT4, UPFS) and more. Must have good organisational skills and be able to meet tight deadlines. Must have a good understanding of the South African healthcare system. Insurance jobs