Senior Manager: Networks and Provider Relations – Medical Scheme - Pretoria
Key Performance Areas (KPAs):
Fulfil various stakeholder engagements as directed by the Chief Healthcare Officer.
Manage all activities related to the Scheme’s provider relations and network management.
Manage all healthcare network contracts in line with Scheme strategy.
Management of Service Level Agreements with the Scheme’s Service Providers.
Develop and maintain the Scheme’s provider relations strategy.
Support other scheme divisions in provider relations and network management activities; and
Manage the divisional budget in line with budget allocation.
Manage the Scheme’s provider relations and sponsorship budget in line with Scheme policy.
Support the Scheme’s reimbursement arrangements with network providers.
Support the Scheme’s year end tariff negotiations.
Drive continuous improvement and on-going management of services.
Develop and maintain a general technical understanding of tariff files and how these are downloaded to assist in provider and network management.
Ensure the performance of all statistical analyses required for provider relations and network management.
Ensure successful implementation of the Scheme’s annual Provider Relations work plan.
Manage the end to end process from designing, planning, implementation and maintenance of comprehensive standard operating procedures and policies.
Formulate, review and approve stakeholder communication.
Establish sound mechanisms to enhance and integrate provider relations and network management services.
Maintain regular and scheduled communication with identified stakeholder groups.
Maintain sound relationships with all provider groups.
Engage with identified healthcare provider groups (hospital groups, pathologists and other providers) on relevant provider relations and network management matters.
Communicate and Implement corrective measures where predetermined objectives are not met.
Performs program and project management function for the Healthcare Management Division, inclusive of the development, implementation and monitoring of Strategic and operational work plans.
Manage training, development and mentorship of staff on all provider relations and stakeholder management.
Manage all the staff in the unit in accordance with the scheme’s HR Policy.
Qualification, skills and competencies requirements are:
Degree in Clinical Sciences (medical/ nursing/ physiotherapy/psychology etc.) and/or other relevant/ equivalent qualification and a Post graduate qualification or equivalent NQF level 8 qualification.
Minimum 7 years work experience in the healthcare funding/ medical Scheme industry.
Minimum 5 years as Manager/Supervisor in the healthcare funding/ medical Scheme industry;
A good understanding of the Medical Schemes Act.
Must have excellent computer literacy and MS 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 have the ability to attention to detail and be a self-starter.
Have the ability to work well as part of a team.
Must be in possession of a valid driver’s license and own vehicle and be willing to travel at short notice.
A good understanding all coding (Nappi, Tariffs, ICD10, CPT4, UPFS and more.
Good organisational ability and able to meet tight deadlines.
Must have a good understanding of the South African healthcare system.
Must have experience in provider network and relationship management.