Accountable for the provision of specialist knowledge, delivery plans and associated practices to minimise the Scheme’s financial risk by developing and maintaining key relationships with health provider networks. This role is also accountable for identifying and implementing the roll out of the approved and suitable Scheme health provider networks in line with the Clinical Risk strategy.
Network Analysis and Strategy
- Identify gaps in our current network arrangement and develop a comprehensive plan to mitigate and close these gaps.
- Align network development with our Clinical Risk strategy.
- Implement, manage, and monitor the return on investments for recommended and approved networks.
Provider Contracting and Relationship Management:
- Recruit and negotiate contracts with providers.
- Resolve provider-related issues and provide ongoing education.
- Foster strong relationships with our provider stakeholders.
Project Management:
- Lead provider network management projects.
- Provide regular updates to relevant stakeholders.
- Ensure effective communication throughout the project lifecycle.
Risk Mitigation and Compliance:
- Manage risk profiles within the department.
- Implement sound governance and compliance processes.
- Support internal and external audits.
Financial Perspective:
- Monitor provider performance standards, including claims loss ratio.
- Oversee negotiated tariffs as per our approved Scheme mandate.
- Contribute to annual budget planning and implementation.
Team Leadership:
- Build and lead a cohesive team.
- Drive talent acquisition, development, and retention strategies.
- Foster a high-performance culture.
EXPERIENCE AND QUALIFICATION
B Cur degree or 4 year Nursing Diploma
Minimum of 5 years Managerial experience
Proven experience in the Provider Network Management within a Medical Scheme or Medical Aid Administrator
Excellent communication and negotitation skills
Knowledge of healthcare regulations and compliance
OWN VEHICLE AND VALID DRIVERS LICENCE IS ESSENTIAL
Desired Skills:
- registered nurse
- provider network experience
- medical scheme knowledge is essential