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Manager - Medical Operations

2 weeks ago

Parktown, South Africa Rand Mutual Assurance Full time

**THE JOB AT A GLANCE**

As the Manager - Medical Operations, you will be responsible for all aspects of Managed Care within the Medical Operations section.

**WHAT WILL YOU DO?**
- Managed care of hospital admissions and downstream cost
- Oversee and support team leaders pension medical case auditors and case management
- Analysis of hospital medical spend and provider usage patterns
- Identify and establish potential provider networks
- Regular communication to hospitals and provider network sharing RMA information and industry trends
- Assist and training of RMA staff on managed care
- Address risk management and mitigating actions appropriately
- Identify gaps and shortfall of subordinates on performance and agree on personal development plan
- Management of departmental budget
- Review and update of medical policies and protocols on managed care with publishing on share point
- Attend committee meetings
- System update and signed agreement of negotiated tariffs
- Risk management actions appropriately addressed
- Submission of monthly reports within the first 3 working days of any new month or within the stipulated deadline for ad hoc reports
- Service levels measured on the average delay of contact centre referrals (Annexure E)
- Conduct regular visits and information sessions with hospitals
- Budget management.

**WHAT WILL YOU GET IN RETURN?**

We offer great opportunities for personal and professional development in a stable company that is 130 years strong. The role comes with a competitive salary package and various benefits. Furthermore, you will be part of a dedicated group of colleagues who value teamwork and collaboration.

**Turnaround time**

**Our Commitment to transformation**:
**WHAT YOU'LL BRING TO THE TABLE?**
- Relevant clinical/ medical qualification in Nursing/ Nursing Science
- Experience in Managed Care and health management
- Client liaison
- Insurance background
- Valid Drivers’ license
- 3 - 5 years relevant industry experience with 2 - 3 years managerial experience in the managed care and medical insurance environment
- Building Trust skill
- Customer Focus skill
- Driving for Results skill
- Leadership Disposition skill
- Selecting Talent skill
- Facilitating Change skill
- Aligning Performance for Success skill
- Ability to gain commitment
- Decision Making skill
- Be objective
- Knowledgeable Information and Information Management and Analysis
- Be Patient
- Have a Project wide perspective
- Be resourceful
- Be self-motivated.