In Hospital Patient Services Manager

2 days ago

Gauteng, South Africa LetsLink Medical Recruitment Agency Full time

Our client is seeking to employ a Registered Nurse with management skills who has experience in the Medical Insurance industry and knowledge and skills in Hospital Benefit Management.

**Key Areas of Responsibility**
- Provide input into the development of the division’s strategy.
- Develop a supporting tactical plan for the Clinical Risk sub-division to ensure execution of the strategic objectives and goals.
- Drive the implementation of the tactical plan by developing and allocating operational activities and ensuring alignment to the achievement of operational targets.
- Ensure the establishment, maintenance and improvement of Standard Operating Procedures, policies, and guidelines relating to the Clinical Risk division in consultation with the Executive: Operations.
- Use insights gained through business information to compile reports, and metrics to measure success and inform the business decision making process and realign objectives.
- Monitor and continuously evaluate progress of the division’s achievements against the tactical plan and strategic objectives.
- Ensure overall provision and management of a cost-effective and competitive Hospital Benefit Management Services
- Investigate and provide high level input into the resolution of escalated queries received from the Operations division and 3rd party managed care organisations to ensure effective feedback to members and in accordance with set SLA.
- Identify and target cost drivers in the schemes healthcare expenses.
- Develop and implement a plan to manage and monitor the return on investments of recommended and/or approved networks.
- Develop and maintain performance measures for 3rd party services in accordance to agreed SLA.
- Evaluate the quality improvement activities of managed care organizations as per contractual agreement
- Assisting in the conceptualisation, planning and implementation of new managed care products
- As part of a team, develops, implements and executes management strategies with third party companies for compliance with standard guidelines, and scheme rules
- Ensure compliance with legal and procedural guidelines
- Performs other duties, ad hoc projects, and special assignments as required
- Provide input into the division’s risk register in consultation with the Manager: ARC.
- Responsible for the coordination and maintenance of quality risk management in line with the requirements from ISO9001:2015.
- Monitor changes in the regulatory environment and ensure that appropriate operational controls are implemented to address new requirements.
- Support and provide evidence to all internal, external and ISO audit requirements.
- Oversee the maintenance and enforcement of all technical related Service Level Agreements to minimise business risk and ensure business continuity.
- Ensure adherence in the Clinical Risk team to all relevant laws, policies and Standard Operating Procedures throughout the organisation.
- Provide input in the planning and compilation of the division’s annual budget aligned to the tactical delivery plans to support the implementation of set objectives.
- Ensure the effective implementation, management, monitoring of the division’s budget, and mitigate and report on any variances.
- Ensure the deployment of proper financial controls to manage the divisional budget.
- Report on and communicate any costs improvements and shortfalls.
- Build and lead an effective and cohesive team through the effective management of divisional resources.
- Drive the implementation of talent acquisition, succession planning, development, and retention strategies for the division.
- Ensure the enhancement of relevant knowledge and skills through continuous coaching, mentoring and nurturing of divisional talent.
- Create a high performance culture and manage team performance effectively by translating and communicating the annual performance goals and measures into individual work plans based on agreed upon objectives.
- Ensure that the working environment contributes to improving employee engagement, recognition and increased productivity.
- Ensure that management of poor performance and disciplinary matters in line with the Schemes policies and procedures.
- Identify and mitigate internal systems and procedural barriers to enhance excellent customer service.
- Build and maintain effective internal and external stakeholder relationships for the purpose of expectations management, knowledge sharing and integration.
- Represent and participate in the organisation’s committees and tasks teams when required.
- Convene and attend meetings and present findings and business cases to relevant stakeholders when required.
- Implement timeous communication on progress and challenges in achieving the tactical work plans to impacted stakeholders.
- Attend industry related forums, conferences and workshops to gain industry insight for the purpose of business improvement.

**Knowledge**
- Relevant legislation and regulatory

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