Accountable for the provision of specialist knowledge, delivery plans and associated practices to minimize the Scheme’s financial risk by developing and maintaining key relationships with health provider networks. This role is also accountable for identifying and implementing the roll out of the approved and suitable Scheme health provider networks in line with the Clinical Risk strategy.
- Analyse and identify gaps in the Scheme’s current network arrangement and put a plan to mitigate and close the identified gaps, in line with the Clinical risk strategy.
- Develop a plan, implement, manage and monitor a return on investments of the recommended and/or approved networks.
- Develop, implement and manage provider contracting to include provider recruitment, contract negotiation, provider education and problem resolution.
- Develop and implement provider network management projects and ensure adequate feedback on the project status.
- Coordinate and facilitate end-to-end project management principles for multiple projects and provide updates accordingly, to the relevant stakeholders.
- Accountable for the mitigation of the department’s risk profile as well as implementing sound governance and compliance processes to identify and manage risk, in the management of the function.
- Ensure that all contracts are accurate and concluded timeously, in consultation with the legal department.
- Support and provide evidence of all audit requirements as required by internal and external audit Service Provider.
- Continuous evaluation and monitoring of providers performance standards.
- Accountable for providing input in the planning and compilation of the department’s annual budget aligned to delivery plans to support the implementation of set objectives.
BEE candidates. MUST have experience in MEDICAL AID INDUSTRY or application will not be accepted.
B Degree or Diploma in Health related field