Senior Manager: Provider Relations – Pretoria – Medical Scheme

Senior Manager: Provider Relations – Pretoria – Medical Scheme

Key Performance Areas (KPAs):

ü  Oversee an annual review of SPN contracts

ü  Oversee divisional Contracts, Risk and Compliance Management 

ü  Manage the performance of the Scheme’s SPN.

ü  Oversee seamless operational integration across the SPN

ü  Coordinate visits with all SPN.

ü  Manage the development, review and maintenance of operational SOP’s and business processes.

ü  Set annual performance targets for SPN members.

ü  Manage the development and maintenance of service level performance.

ü  Oversee the implementation of service standards against the Scheme’s business requirements.

ü  Manage the development and maintenance of service level performance.

ü  Oversee the implementation of service standards against the Scheme’s business requirements.

ü  Assess contracted provider business processes and operations as per agreements.

ü  Manage the review and recommendation of SPN contract renewals

ü  Manage the compliance of regularity requirements by the SPN.

ü  Develop and maintain a Disaster Recovery Policy for the SPN.

ü  Manage of the SPN related Forum.

ü  Identify and recommend SPN non-performance penalties

ü  Continuously identify and recommend areas where performance efficiencies can be realised.

ü  Plan, prepare and review deliverables in various forms including written reports, presentations and discussions with the client

ü  Share technical and other knowledge with your team and the department

ü  Develop an operational plan which incorporates goals and objectives that work towards the strategic direction of the Scheme

ü  Develop an operational plan which incorporates goals and objectives that work towards the strategic direction of the Scheme

ü  Accomplishes staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counselling, and disciplining employees; initiating, coordinating, and enforcing systems, policies, and procedures

Qualification requirements are:

ü  A relevant 3year Degree, Diploma or NQF equivalent and a post graduate qualification;

ü  Qualifications and experience in Risk, Contract and Compliance Management;

ü  At least 8 years of functional work experience with 5 years Management experience;

ü  At least  8 years’ experience within Managed Care environment,

ü  SANC Registration advantageous;

ü  Experience and understanding of Contract and Risk management tools

ü  Self-motivated with the ability to prioritize, meet deadlines, and manage changing priorities;

ü  Ability to read and comprehend strategic documents

ü  Proven ability to be flexible and work hard, both independently and in a team environment;

ü  Ability to give direction and engage with various stakeholders

ü  Experience in the healthcare funding/ medical Scheme industry essential;

ü  Excellent computer literacy and MS Office skills, including Microsoft Project;

ü  Excellent Presentation skills

ü  Experience in System Development Life Cycle is a must;

ü  Sound qualitative and quantitative analysis skills;

ü  Excellent communication and writing skills;

ü  Strong analytical skills with attention to detail; and

ü  Must be a self-starter.

thuto.