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Senior Manager: Networks and Provider Relations – Medical Scheme - Pretoria

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.

Job Requirements: 

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.

Job Type: 

Permanent

Company Name: 

Growthlink Consulting

Company Location: 

Click here to apply

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