Senior Manager: Healthcare Networks and Provider Relations at Government Employees Medical Scheme RSA

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.