Executive: Managed Healthcare at PPS

Minimum Requirements

Education: 

• 3 – 5 years executive management experience essential
• Successful track record in a corporate managed healthcare environment advantage.
• Good knowledge of contractual agreements and legal alignments thereof, an advantage.
• Member of appropriate professional medical bodies e.g. SAMA, SAPC, SANC etc
• Good knowledge of the Medical Schemes Act No. 131 of 1998 preferred.
• Clinical protocol development and disease management experience essential .

Knowledge and Skills:

• Demonstrable competency in strategic planning and business development.
• Managing process and people to meet strategic objectives.
• Demonstrates awareness of industry trends and opportunities and keeps up to date with competitor developments impacting area of responsibility.
• Working knowledge of data analysis and performance/operation metrics.
• Working knowledge of IT/Business infrastructure and MS Office.

Duties and Responsibilities

Key Responsibilities 

• Plan, develop & implement strategy for operational management & development so as to meet agreed organisational performance plans within agreed budgets and timescales (covering relevant areas of operation i.e. Clinical Risk/ Medicine Management/ Disease Management/ Preauthorisation/ Case Management/ Wellness Programmes and Medical Underwriting).
• Establish and maintain appropriate systems for measuring necessary aspects of operational management and development.
• Monitor, measure and report on operational issues, opportunities and development plans and achievements within agreed formats and timelines.
• Manage and develop direct reporting staff.
• Manage and control organisational expenditure within agreed budgets.
• Liaise with other functional business unit managers so as to understand all necessary aspects and needs of operational development, and to ensure that they are fully informed of operational objectives, purposes and achievements.
• Maintain awareness and knowledge of organisational strategy and provide suitable interpretation to managers and staff in the organisation thereby ensuring successful implementation thereof.  
• Continuously contribute to the evaluation and development of organisational strategy and performance in co-operation with the executive team.
• Be aware and act on all opportunities for increasing the client base and obtaining new business.
• Establish profitable relationships with new and existing clients.
• Ensure activities meet with and integrate with organisational requirements for quality management, health and safety standards, legal stipulations, environmental policies and general care of duty.
• Execute responsibilities of a company director according to lawful and ethical standards in alignment with PPS Healthcare Administrators’ Code of Ethics.
• Remain aware of competitor products and activities relevant to maximising revenue.
• Remain abreast of market trends and give feedback to the CEO. 
• Deliver the highest standards of customer service through management to achieve business, improve long-term customer retention and secure referral business.
• Assist in medical scheme product development and benefit design.
• Manage and develop core product diversification. 
• Assist and compliment the efforts of the Principal Officer in the areas related to care coordination and managed care for scheme members.