Senior Manager: Managed Care

3 weeks ago

Pretoria, South Africa Medihelp Medical Scheme Full time

Responsible for the overall management of the Medicine and Healthcare (pre-auth, case management and hospital audit) divisions through the following actions:
Ensure all registered Medihelp benefits are clinically defined and that protocols and algorithms are uploaded to the system;
Develop clinically defined protocols and algorithms for pharmaceutical benefits;
Ensure claims are paid in terms of pre-authorisation given; and
Ensure pre-authorisations and cases are managed in accordance with system-driven protocols and algorithms.
Responsible for the overall management of the Provider Administration division through the following actions:
Ensure all designated service providers (DSPs) have contracts in place and that their tariffs are uploaded on the system;
Ensure all DSPs adhere to protocols and tariffs;
Ensure training for DSPs; and
Maintain all healthcare providers’ details.
Oversee the management of high-cost admissions and high-cost cases.
Serve as part of the team responsible to manage CMS complaints.
Draft, review and negotiate contracts with third-party service providers to ensure delivery of services required to manage healthcare costs.
Identify areas for improvement on processes, e.g. business to business initiatives and process automation.
Establish an appropriate structure to achieve objectives and manage the business unit’s actions, staff complement and resources.
Compile and monitor a risk register.
Ensure constant operational efficiency through innovation within areas under control.
Ensure adherence to all legislative and regulatory prescripts.
Continuously evaluate plans, actions and resources to ensure that objectives are achieved.
Manage the budget in order to utilise resources effectively and achieve objectives.

**Paterson D5**:
An applicable clinical tertiary diploma.
Eight years’ relevant experience, of which two years must be in managed care and four years on management level.

**Paterson E1**:
Four-year clinical degree.
Eight years’ relevant experience, of which two years must be in managed care and four years on management level.

**Must possess knowledge of the following**:
The Medical Schemes Act and Regulations;
Managed healthcare programmes, processes and systems.
Coding (ICD-10, PMB, NAPPI, CPT and RPL); and
Industry practices and trends.
Computer literate in MS Office (advanced).
Agile Leadership competencies (Delivering results, Empowering others, Continuous improvement)
Enabling competencies (Data analytics, Solutioning complexity)
Core competencies (Collaboration & Teamwork, Managing Resources, Communicating with impact, Customer focus, Planning & Organising)

**Closing date**: 3 March 2023

  • Operations Manager

    4 weeks ago

    Pretoria, South Africa care force Full time

    Our client, a managed care organisation based in Pretoria is looking for an Operations Manager. This is an equal opportunity organisation with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries. Position: Operations ManagerReporting to: Life Business ExecutiveGrade: D5Hours: 8 Hours per day, 40 hours...

  • Case Manager

    4 weeks ago

    Pretoria, South Africa care force Full time

    Our client, a managed care organisation based in Pretoria is looking for a Case Manager. This is an equal opportunity organisation with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries. Position: Case Manager (Member Management) Reporting to: Senior Specialist Clinical Management Location: On-site...

  • Operations Manager

    3 weeks ago

    Pretoria, South Africa National Renal Care Full time

    National Renal Care has grown and evolved into the leading total kidney disease management organisation that provides person-centered health and care, which is digitally enabled, and data driven. National Renal Care seeks to recruit an ambitious, talented, goal driven and self-motivated individual to fulfil the role of an Operations Manager. KEY PERFORMANCE...

  • Customer Care Manager

    4 weeks ago

    Pretoria, South Africa H2R Africa Full time

    **Responsibilities**: - Oversee and report on the general operations and functions of the client relationship and key account management team. - Ensure that the team operates cohesively within the department. - Be accountable for high retention levels and building meaningful relationships with key stakeholders. - Execute the aggressive organic growth...

  • Unit Leader

    4 weeks ago

    Pretoria, South Africa National Renal Care Full time

    National Renal Care has grown and evolved into the leading total kidney disease management organisation that provides person-centered health and care, which is digitally enabled, and data driven. National Renal Care seeks to recruit an ambitious, talented, goal driven and self-motivated individual to fulfil the role of a Unit Leader. The Unit Leader will be...

  • Unit Leader

    4 weeks ago

    Pretoria, South Africa National Renal Care Full time

    **Job Ref #**: 00393 **Industry**: Pharmaceutical And Medical/Healthcare **Job Type**: Permanent **Salary**: Market Related Description: National Renal Care has grown and evolved into the leading total kidney disease management organisation that provides person-centered health and care, which is digitally enabled, and data driven. National Renal Care seeks...

  • Pre-authorisation Consultant

    5 days ago

    Pretoria, South Africa care force Full time

    **Description**: Position: Coordinator: Member Care (Pre-authorisations) Reporting to: Contact Centre Operational Manager Location: On-site at the Head Office, Pretoria - **You will be required to work shifts between 7h00 and 19h00 (Monday to Sunday)**_ **Qualifications**: - Registered/ Enrolled Nurse - Valid registration with SANC **Skills and...

  • Sales Manager South Africa

    4 weeks ago

    Pretoria, South Africa Edwards Lifesciences Full time

    Manages a team of territory/account managers across a defined region to achieve financial goals. Responsibilities encompass management and coaching of the team, supporting team in direct sales activities and driving business with own customers. **Key Responsibilities**: - Manages, coaches and motivates a small team (3 headcounts) to ensure achievement of...

  • Unit Manager Surgical Ward and High Care

    4 weeks ago

    Pretoria, South Africa Mass Staffing Projects Full time

    **Job Information** - Location- Pretoria- Salary- R550k-R450k- Job Type- Permanent- Education- Degree/Diploma in Nursing- Experience- +3 years’ management experience- - pharmacy.jobs(at)staffingprojects.co.za- Fax- 0866023398Are you looking for a career change? A vacancy for a Unit Manager Unit Manager Surgical Ward and High Care at a private hospital in...

  • Healthcare Worker/stock Controller

    4 weeks ago

    Pretoria, South Africa National Renal Care Full time

    National Renal Care has grown and evolved into the leading total kidney disease management organisation that provides person-centered health and care, which is digitally enabled, and data driven. National Renal Care seeks to recruit an ambitious, talented, goal driven and self-motivated individual to fulfil the role of a Health Care Worker/Stock...

  • Technical Driver

    7 days ago

    Pretoria, South Africa National Renal Care Full time

    National Renal Care has grown and evolved into the leading total kidney disease management organisation that provides person-centered health and care, which is digitally enabled, and data driven. National Renal Care seeks to recruit an ambitious, talented, goal driven and self-motivated individual to fulfil the role of a Driver. KEY PERFORMANCE AREAS -...

  • Brand Manager

    5 days ago

    Pretoria, South Africa Amka Products Full time

    Amka, a leading manufacturing company, is looking for a Brand Manager to look after brands in Skincare Marketing. In a recent ranking of SA's top 500 companies, the Topco Media Research Foundation recognized Amka as the Best Managed Company in the Personal Products sector. PLEASE DO NOT APPLY IF YOU DO NOT MEET THE BELOW 3 ESSENTIAL CRITERIA. MUST HAVE a...

  • Sales Executive

    2 weeks ago

    Pretoria, South Africa MF Spa & Beauty Placements Full time

    SALES EXECUIVE - Skin Care, Body Therapies & Slimming GAUTENG NORTH (Pretoria / Midrand, Polokwane, etc.) - South AfricaSTART: June 2024REPORT TO: National Sales ManagerTRADING HOURS & SHIFTS:Monday to Friday 08:00 - 17:00COST TO COMPANY & BENEFITS:R14,000 Basic per monthCommission & Performance IncentivesCompany PETROL cardBrand new cell phone & contract...

  • Sales Executive

    2 weeks ago

    Pretoria, South Africa Miranda Forrester Spa & Beauty Placements Full time

    SALES EXECUIVE - Skin Care, Body Therapies & Slimming GAUTENG NORTH (Pretoria / Midrand, Polokwane, etc.) - South AfricaSTART: June 2024REPORT TO: National Sales ManagerTRADING HOURS & SHIFTS:Monday to Friday 08:00 - 17:00COST TO COMPANY & BENEFITS:R14,000 Basic per monthCommission & Performance IncentivesCompany PETROL cardBrand new cell phone & contract...

  • Senior Financial Manager

    4 weeks ago

    Pretoria, South Africa CTU Career Chatz Full time

    The Senior Financial Manager, who is a Chartered Accountant (CA), is responsible for overseeing the financial operations of an organization, ensuring compliance with accounting and tax regulations, and providing strategic financial advice to senior executives.Responsibilities:Oversee and manage the financial operations of the organization, including...

  • Senior Site Laboratory Manager

    7 days ago

    Pretoria, South Africa SGS Full time

    Company Description SGS is the world’s leading inspection, verification, testing and certification company. SGS is recognized as the global benchmark for quality and integrity. With more than 89,000 employees, SGS operates a network of over 2,600 offices and laboratories around the world. **Job Description**: Reporting to the relevant Regional Manager...

  • Senior Store Manager

    3 weeks ago

    Pretoria, Gauteng, South Africa Pedros Flame Grilled Chicken Full time

    Pedros Flame Grilled Chicken's job vacancy, Career and RecruitmentJob title : Senior Store Manager – Tembisa jobs in GautengJob Location : Gauteng, Deadline : May 23, 2024Quick Recommended LinksJobs by LocationJob by industries Duties & Responsibilities of a Senior Store Manager:Overseeing overall operation of the restaurant/ take-awayEnsuring quality...

  • Coordinator: Member Care

    7 days ago

    Pretoria, South Africa Careforce Recruitment Full time

    Our client, a managed care organisation in Pretoria, are looking for; Position: Coordinator: Member Care (Pre-authorisations) Reporting to: Contact Centre Operational Manager Location: On-site at the Head Office, Pretoria **_You will be required to work shifts between 7h00 and 19h00 (Monday to Sunday) _** **Qualifications**: - Registered/ Enrolled Nurse -...

  • Senior Account Manager

    4 weeks ago

    Pretoria, South Africa SHL Full time

    Job Description Say yes to a better tomorrow! SHL, People Science. People Answers. Do you want to take your sales or account management career to the next level with an established brand but with the energy of a start-up? SHL is a world renowned, fast-growing HR SaaS organization and works with some of the world’s most prestigious global companies who...

  • Operations Manager

    4 weeks ago

    Pretoria, South Africa Careforce Recruitment Full time

    Our client, a managed care organisation based in Pretoria is looking for an Operations Manager. This is an equal opportunity organisation with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries. Position: Operations Manager Reporting to: Life Business Executive Grade: D5 Hours: 8 Hours per day, 40...