Clinical Risk Manager at Health Solutions Africa

About the Job

Role Purpose

• The Clinical Risk Manager will act as a trusted advisor, collaborating with clients to improve health outcomes, reduce risk and ensure that services align with business priorities and client needs.

Requirements

• National Senior Certificate
• The incumbent must have a degree in the field of health (e.g. B.Pharm, BCur)
• A postgraduate leadership qualification would be highly advantageous
• Must be registered with the relevant regulatory body determined by the qualification
• 5 Years' working experience in a managed care environment in a senior operational, managerial or strategic role
• 2 Years' experience in a client facing role
• Knowledge of healthcare industry legislation, trends and competitors
• Knowledge of healthcare management and managed care practices
• Understanding of medical scheme industry rules, regulations and benefit structures
• Must be in possession of a valid driver's licence and own insured vehicle

Duties & Responsibilities
Process

• Foster a strong innovation focus within our Health Risk Management offering to drive continuous improvement and stay ahead in the industry.
• Provide meaningful and relevant appropriate reporting on Health Risk Management functions and trends to enable informed decision-making and proactive risk management.
• Ensure accurate reporting on all strategic, operational and contractual requirements to maintain transparency and accountability.
• Act as the custodian of the Health Risk Management escalation matrix to facilitate efficient issue resolution and escalation processes.
• Inspire collaboration within the Health Risk Management Team and wider business unit to foster a culture of teamwork and knowledge-sharing.
• Assist and support the Head of Operations and Head of HRM strategy in meeting the business needs of clients by aligning strategies and actions accordingly.
• Facilitate the proficient implementation of the Health Risk Management and products strategy to drive successful outcomes.
• Oversee the Managed Care admin interface to ensure the successful application of program specifications throughout the value chain.
• Take accountability for all audit and risk management requirements, ensuring compliance and minimising risk exposure.
• Provide clinical input and assistance as needed in the business to ensure quality and effectiveness.
• Facilitate the adoption of various forms of technology to drive the achievement of beneficiary wellbeing and good clinical outcomes.

Client

• Continuously monitor turnaround times and quality standards, resolving issues promptly to enhance client service delivery and satisfaction.
• Drive the achievement of client service delivery goals in line with predefined standards, ensuring clients receive appropriate advice and exceptional after-sales service.
• Manage client query processes, accurately track and resolve queries, and utilize them as a mechanism to improve client service and streamline business processes.
• Provide risk management expertise and advice to clients and stakeholders, ensuring effective risk mitigation and compliance.
• Build and maintain strong relationships with clients and internal and external stakeholders to foster collaboration and mutual success.
• Contribute to the process of negotiating objective and realistic service level agreements, monitor their appropriateness and recommend adjustments to enhance client satisfaction.
• Make recommendations to improve client services and promote fair treatment of clients within the area of responsibility, ensuring high levels of client satisfaction.
• Actively participate and contribute to a culture that builds rewarding relationships, facilitates feedback and consistently delivers exceptional client service.

People

• Create a positive work climate and culture to energise employees, give meaning to their work, minimise work disruption and maximise employee productivity.
• Demonstrate exemplary leadership behaviour through personal involvement, commitment and dedication in support of organisational values.
• Drive a culture that guides and directs best practices, fostering an environment of continuous learning, improvement and cohesiveness.
• Enable a learning and growth culture where information regarding successes, issues, trends and ideas is actively shared between team members, promoting collaboration and innovation.

Financa

• Implement and manage financial risk methodologies, techniques and systems to effectively monitor and report on financial activities.
• Implement and provide feedback on the effectiveness of financial policy, practice and procedures preventing illegal, unethical or improper conduct.
• Implement risk management, governance and compliance policies in own practice area to identify and manage governance and risk exposure liability.
• Investigate reported wilful acts of non-compliance to organisational policy and practice and report on findings to ensure adherence to compliance standards.

Competencies

• Collaboration
• Business acumen skills
• Client relation skills
• Change management skills
• Innovation skills
• Report writing skills
• Strategic thinking
• Influencing skills
• Customer relationship management
• Strategy translation skills