Executive: Managed Healthcare

4 days ago

Centurion, South Africa PPS Recruitment Full time

**Job Advert Summary**:
We are looking for an outstanding leader to support the CEO by providing strategic direction aimed at enhancing broader access of the organisation’s products and services to members of medical aid schemes, as well as ensure that the organisation is a key player in the provision and delivery of managed healthcare services through forging close ties with key stakeholders. Managing the achievement of all managed healthcare targets for defined areas within the full spectrum of managed healthcare services sought by clients in the health insurance market. To provide new and innovative managed healthcare solutions within the health insurance industry.To contribute to the increase of profitability of the organisation by effectively planning, organising, leading & controlling operations thereby also ensuring that the existing business is maintained

**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.

**Competencies**:

- Outstanding organizational and leadership abilities.
- Excellent interpersonal and public speaking skills.
- Aptitude in decision-making and problem-solving.
- Have proven and demonstrable leadership and management abilities.
- The ability to understand financial and economic concepts/drivers; to identify, create and/or exploit opportunities.
- Understands and monitors the market, competitors, trends, key business drivers and metrics and makes effective decisions to drive profitability, service excellence and sustainability.
- The ability to evaluate and redirect organisational strategy, value proposition, and business strategy aimed at conceptualising a desired future state that promotes the viability of the organisation.

**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 fo

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