![Kaelo](https://media.trabajo.org/img/noimg.jpg)
Partner Networks Manager
4 months ago
Company Description
Kaelo provides essential healthcare solutions ensuring the physical and psychosocial wellbeing of all South Africans towards lasting social change. Kaelo meets the Healthcare needs of Corporate and Retail clients across South Africa - products offerings include Medical Insurance, Medical Aid, Gap Insurance, Kaelo Money and employee assistance programmes.
**Job Description**:
The Partner Networks Operations Manager is responsible for the management of the multi-disciplinary network ensuring that contractual obligations (management of Contacts and Service Level Agreements) with medical schemes, insurance and primary care products are established and maintained. They are also responsible for maintaining strong relationships and the implementation, management and maintenance of standards and quality assurance.
KEY OUTCOMES
Stable national network of providers ensuring that the member base has access to a contracted provider
Network Management
Support the business by ensuring that members and policyholders have access to primary healthcare benefits via a multidisciplinary network of healthcare providers at an affordable and sustainable rate.
Drive the strategic objectives of the company by ensuring network growth and stability, a happy educated provider who is a partner in the delivery of rational appropriate and cost-effective healthcare.
The ownership and management of the primary care benefit stack, ensuring that the benefits marketed and sold can be delivered efficiently via the administration system and network of providers.
Train providers in keeping with Prime Cure services, policies and procedures.
Develop and implement sound administrative, communication and operational systems to ensure consistent service delivery
Set work standards and ensure that these standards are met
Implement quality assurance procedures within the provider network
Resolve queries between funders, Prime Cure and service providers.
Ensure all interactions with providers are documented and SOP’s are followed
They will have oversight of the following items which are implemented by the Networks team:
All providers contracted to Prime Cure must have signed a valid contract and completed the information sheet and provided Prime Cure with all required documentation, for example BHF registration, HPCSA certificate
Management of yearly Confirmation of Service Agreements upon communication of new rates
Annual Fee negotiations with various providers including the Hospital networks, pharmacy groups, laboratories and other disciplines.
Ensure Managed Care Accreditation
Member and Provider Risk Management
The Partner Networks Manager supports and manages the design, implementation and evaluation of member/policyholder management and provider utilisation programmes thereby ensuring that members receive, and providers provide rational appropriate cost-effective healthcare. The main objective of these programmes is to ensure that members lead a healthy, happy, and productive life
Product and Scheme Management
The Partner Networks Manager ensures that the numerous Kaelo Health option benefits including that of Schemes, white label products and other Insurer products have the related documentation and delivery is as per the rules and policy documents.
Negotiations of fees with all providers - contracted and non-contracted
Co-ordination and management of provider profiling, peer review and intervention with outliers
Risk Analysis as a member of the risk forum
Demographics
Geographic’s
Individuals to groups
Utilisation
Identification of high-risk high claiming members
Disease Burden
Employer profile
Client executive of Prime Cure clients including Schemes
Negotiation of contracts and fees
Design of products and benefits
Analysis of risk factors and potential solutions
Service level agreement management
Ensure that each service level agreement is adhered to and met by the relevant business unit owner
Monitor trends within the business that may adversely affect the SLA and ensure the line manager and relevant business unit owners are kept informed
Ensure all queries are dealt within contracted SLA
Ensure all provider details are kept up to date on MIP and provider lists
Reporting
Compile daily, monthly, quarterly, and ad hoc reports with precision and quality and submit these internally and externally at the agreed deadline dates for providers allocated to you
Collect data timeously for the compilation and completion of reports to Divisional Head Network and Risk executive
Complete quality audits monthly on all network related SOP’s
Utilisation
Claims to capitation fee ratio
Effect of managed care interventions
Underwriting
**Qualifications**:
SPECIAL REQUIREMENTS
Communication skills, Industry experience and knowledge
PERSON DETAILS: WORK EXPERIENCE
REQUIRED
At least 5 years’ experience in the healthcare Industry/ Insurance at a senior level
3 years project management/paralegal experience
PREFERRED
EDUCATION:
-
Domain Consultant, Network Security
2 weeks ago
Johannesburg, South Africa Palo Alto Networks Full time**Company Description** Our Mission** At Palo Alto Networks® everything starts and ends with our mission: Being the cybersecurity partner of choice, protecting our digital way of life. Our vision is a world where each day is safer and more secure than the one before. We are a company built on the foundation of challenging and disrupting the way things are...
-
Domain Consultant, Network Security
2 weeks ago
Johannesburg, South Africa Palo Alto Networks Full timeJob DescriptionYour CareerAs a domain consultant for network security transformation, you provide technical expertise and guidance in customers' network security and zero trust journey. You will be key in defining technical solutions that secure a customer’s key business imperatives. You evangelize our industry leadership in on-prem, cloud, and...
-
Network Security Transformation Consultant
7 days ago
Johannesburg, Gauteng, South Africa Palo Alto Networks Full timeAbout the RoleWe are seeking a highly skilled Domain Consultant to join our team at Palo Alto Networks. As a key member of our organization, you will play a critical role in defining technical solutions that secure our customers' key business imperatives.Key ResponsibilitiesCollaborate with sales teams to recommend and develop customer solutions within your...
-
Network Security Transformation Expert
2 weeks ago
Johannesburg, Gauteng, South Africa Palo Alto Networks Full timeAbout the RolePalo Alto Networks is seeking a highly skilled Network Security Transformation Expert to join our team. As a key member of our Domain Consultant team, you will play a critical role in defining technical solutions that secure our customers' key business imperatives.Key ResponsibilitiesCollaborate with Sales Teams: Work closely with sales teams...
-
Named Account Manager, Public
5 months ago
Johannesburg, South Africa Palo Alto Networks Full time**Company Description** Our Mission** At Palo Alto Networks® everything starts and ends with our mission: Being the cybersecurity partner of choice, protecting our digital way of life. Our vision is a world where each day is safer and more secure than the one before. We are a company built on the foundation of challenging and disrupting the way things are...
-
Channel Systems Engineer
4 weeks ago
Johannesburg, South Africa Palo Alto Networks Full timeOur Mission At Palo Alto Networks® everything starts and ends with our mission: Being the cybersecurity partner of choice, protecting our digital way of life. We have the vision of a world where each day is safer and more secure than the one before. These aren’t easy goals to accomplish – but we’re not here for easy. We’re here for better....
-
Commercial Sales Manager
4 weeks ago
Johannesburg, South Africa Palo Alto Networks Full time**Company Description** Our Mission** At Palo Alto Networks® everything starts and ends with our mission: Being the cybersecurity partner of choice, protecting our digital way of life. Our vision is a world where each day is safer and more secure than the one before. We are a company built on the foundation of challenging and disrupting the way things are...
-
Regional Sales Manager
5 months ago
Johannesburg, South Africa Palo Alto Networks Full timeCompany Description **Our Mission** At Palo Alto Networks® everything starts and ends with our mission: Being the cybersecurity partner of choice, protecting our digital way of life. Our vision is a world where each day is safer and more secure than the one before. We are a company built on the foundation of challenging and disrupting the way things are...
-
Regional Sales Manager
4 months ago
Johannesburg, South Africa Palo Alto Networks Full time**Company Description** Our Mission** At Palo Alto Networks® everything starts and ends with our mission: Being the cybersecurity partner of choice, protecting our digital way of life. Our vision is a world where each day is safer and more secure than the one before. We are a company built on the foundation of challenging and disrupting the way things are...
-
Regional Sales Manager
6 months ago
Johannesburg, South Africa Palo Alto Networks Full timeCompany Description **Our Mission** At Palo Alto Networks® everything starts and ends with our mission: Being the cybersecurity partner of choice, protecting our digital way of life. Our vision is a world where each day is safer and more secure than the one before. We are a company built on the foundation of challenging and disrupting the way things are...
-
Regional Sales Manager
6 months ago
Johannesburg, South Africa Palo Alto Networks Full timeCompany Description **Our Mission** At Palo Alto Networks® everything starts and ends with our mission: Being the cybersecurity partner of choice, protecting our digital way of life. Our vision is a world where each day is safer and more secure than the one before. We are a company built on the foundation of challenging and disrupting the way things are...
-
Sales Manager Networking
3 months ago
Johannesburg, South Africa Pollock and Associates Full timeSales Manager Networking ICT Johannesburg - Gauteng - South Africa As the Sales Manager of Networking, your role is to be a key driver of business growth and revenue within the networking sector. With a track record of 3 years in a similar role, you will bring practical experience in selling networking products and a strong ability to negotiate...
-
Regional Sales Manager, Cortex
5 months ago
Johannesburg, South Africa Palo Alto Networks Full timeCompany Description **Our Mission** At Palo Alto Networks® everything starts and ends with our mission: Being the cybersecurity partner of choice, protecting our digital way of life. Our vision is a world where each day is safer and more secure than the one before. We are a company built on the foundation of challenging and disrupting the way things are...
-
Regional Sales Manager, Cortex
5 months ago
Johannesburg, South Africa Palo Alto Networks Full timeCompany Description **Our Mission** At Palo Alto Networks® everything starts and ends with our mission: Being the cybersecurity partner of choice, protecting our digital way of life. Our vision is a world where each day is safer and more secure than the one before. We are a company built on the foundation of challenging and disrupting the way things are...
-
Named Account Manager
5 months ago
Johannesburg, South Africa Palo Alto Networks Full timeCompany Description **Our Mission** At Palo Alto Networks® everything starts and ends with our mission: Being the cybersecurity partner of choice, protecting our digital way of life. Our vision is a world where each day is safer and more secure than the one before. We are a company built on the foundation of challenging and disrupting the way things are...
-
Commercial Sales Manager
4 weeks ago
Johannesburg, South Africa Palo Alto Networks Full timeJob DescriptionYour CareerOur Commercial Sales Team is an important driver of company revenue and growth. As an experienced and dynamic sales professional, you will be responsible for leading and driving sales engagements into assigned commercial accounts. In this role, you are motivated by the desire to solve critical challenges facing our customer’s...
-
Network Development Manager
4 months ago
Johannesburg, South Africa Facebook App Full timeTo support the fast growing user community and the introduction of new and innovative products and services, we are continually expanding our backbone network infrastructure around the globe. We are looking for a Network Development Manager (fka Network Investment Manager) to join our EMEA network infrastructure group to support our growing network footprint...
-
Senior Client Partner
3 months ago
Johannesburg, South Africa NTT DATA Full timeJob Description Make an impact with NTT DATAJoin a company that is pushing the boundaries of what is possible. We are renowned for our technical excellence and leading innovations, and for making a difference to our clients and society. Our workplace embraces diversity and inclusion – it’s a place where you can grow, belong and thrive.Your day at NTT...
-
Domain Consultant
2 weeks ago
Johannesburg, South Africa Palo Alto Networks Full timeJob DescriptionYour CareerAs a domain consultant for network security transformation, you provide technical expertise and guidance in customers' network security and zero trust journey. You will be key in defining technical solutions that secure a customer’s key business imperatives. You evangelize our industry leadership in on-prem, cloud, and...
-
Commercial Sales Director
1 week ago
Johannesburg, Gauteng, South Africa Palo Alto Networks Full timeAbout the RoleWe are seeking a highly motivated and experienced Commercial Sales Manager to join our team at Palo Alto Networks. As a key member of our sales team, you will be responsible for driving sales engagements into assigned commercial accounts and leading the sales process to meet and exceed quarterly/annual quota.Key ResponsibilitiesProspect and...