Clinical Operations Manager

Position Purpose : The Clinical Operations Manager in a Disease Management environment is responsible for overseeing the daily operations and strategic execution of clinical programs designed to support patients with chronic and complex health conditions. This role ensures the effective delivery of coordinated, patient-centred care through evidence-based protocols, with the goal of improving health outcomes, enhancing patient engagement, and reducing healthcare costs. Clinical Operations Manager leads the implementation and optimization of disease management programs across targeted patient populations. The role focuses on aligning clinical processes with organizational goals, ensuring regulatory compliance, optimizing resource utilization, and maintaining a high standard of quality and performance. Experience: Minimum of 5 to 8 years relevant managed care, health risk and clinical customer service within Medical Scheme Administration Industry or similar. Qualifications : Registered Nurse with 3- or 4-years Medical degree/qualification (MANDATORY REQUIREMENT ) Accountabilities: Implement practical solutions that use specialist and departmental systems and processes Provide specialist input and recommendations to improve the efficiency, compliance and quality objectives related to the area of specialisation Identify problems and develop and propose solutions to present to appropriate leader or stakeholders Ensure day to day operational support required from area of specialisation is provided to enhance performance Cost containment Support the identification, development, and implementation of cost-effective processes to increase efficiency and reduce cost drivers related to area of specialisation Continuously review cost / benefit and Return on Investment within area of specialisation Maintain a high level of impact on other departments to support improved delivery Continu continually increase understanding of client and stakeholder needs, satisfaction, and service delivery Knowledge management Ensure that adequate knowledge regarding specialisation is shared as required and maintained within a research library Provide advice and / or training as required Maintain, develop, and implement specialist knowledge within the day-to-day operations of the organisation Be a member of related professional bodies Ensure CPD (continual professional development) or similar accreditation requirements are met annually to ensure maintained specialist accreditation Network key relationships Engage with and provide support to the established network of internal and external expert resources and partners Specialist support to projects Provide Specialist expertise and ensure best practice related to specialisation is implemented in projects, when required Conform to project management disciplines when participating in projects Represent department or project on appropriate committees related to area of specialisation Operational Leadership Select, retain, and grow high performing teams Create highly motivated and engaged operating environments Manage the operational performance of the team as per Human Capital frameworks and policies to ensure delivery to agreed standards and objectives Provide appropriate staff development, coaching and mentoring and retain skilled and engaged employees within the team Support transformation through valuing diversity within the team and department Behave in alignment with the PHA values Position Specific Outputs: Understand and add valuable input into the Scheme’s managed care strategy Communicate the managed care strategy back into the operational environment Proactively identify any potential clinical risks relating to contracted services, and coordinate an appropriate response or action plan from the expert areas within the company to address the identified risk Effectively and timeously prepare the relevant managed care reports for the schemes Articulate the value of the managed care solutions Ensure that the necessary action items from the managed care sub-committees are appropriately attended to. Articulate the schemes strategy and intention from new initiatives and collaborate with operational units to ensure that there is a clear understanding of what the scheme Competency Requirements: Attributes Influence: Engage with Customers and colleagues to advance the organisation’s welfare Entrepreneurship: Take chances to continuously improve our Customer’s experiences Driving operational efficiencies Credibility: Lead with integrity and trust others as you would like to be trusted Ownership: Make critical decisions based on what’s right for the company and Customers Owning operational decisions and knowing oneself Collaboration: Build work-related networks and share knowledge with colleagues Knowledge Knowledge and application of processes and procedures Knowledge and application of relevant legislation Product and scheme rule knowledge Skills Analytical Ability Numerical Ability Attention to Accuracy and Detail Business Writing Skills Report Writing Skills Problem Solving Customer Focus Communication Skills Note: Company reserves the right to close the advert before specified closing date. PHA has its head office in Westville, KwaZulu-Natal. It operates country-wide with a nationally linked network and uses a robust, flexible, as well as integrated system to ensure efficient and effective administration of membership and benefits. #J-18808-Ljbffr