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Senior Manager : Provider Network Relations and Contracting

Senior Manager : Provider Network Relations and Contracting

AfroCentric GroupRoodepoort, Gauteng, South Africa
1 day ago
Job description

Senior Manager : Provider Network Relations and Contracting

To participate in the development, implementation and ongoing management of health risk management initiatives focusing on the central role of healthcare professionals. In addition there is a requirement to engage with client schemes to position and ultimately implement these initiatives

Position Purpose : Human Resource Administrator| Recruiter |Industrial Psychology

Experience :

  • 10 years health care experience relating to provider engagement & relationship management, network management and stakeholder engagement with sound analytical and problem-solving knowledge
  • 5 years’ experience in hospital case management and hospital & provider claims assessing and auditing
  • Leadership experience

Qualifications :

  • Ensure all enhancements are successfully implemented in the organisation
  • Develop products that meet the defined quality requirements and that achieve the desired outputs / improvements
  • Identify operational and system weaknesses and implement refined processes, Standard Operating Procedures and systems
  • Manage Voice of the Customer Surveys and ensure action is taken to address issues, including process innovation
  • Business analysis and documentation of business plans for enhancements and developments
  • Liaison with business process specialists and project managers
  • Drive and oversee / ownership of projects for specific products
  • Understand interdependence of different systems and processes in area of specialisation and department
  • Provide specialist input into efficiency, compliance and quality objectives for relevant area
  • Identify problems and develop and propose solutions to present to appropriate leader or stakeholders

    • Cost containment

  • Improve cost efficiency and reduce wasteful processes through the implementation of strategic projects
  • Manage a budget
  • Support the identification, implementation and development of cost-effective processes to increase efficiency and reduce cost drivers
  • Continuously review cost / benefit and ROI
  • Interfacing with 3rd parties and service provider networks
  • Maintain a high level of inter-departmental understanding in order to deliver on professional excellence
  • Continuously increase understanding of client and stakeholder needs, satisfaction and service delivery

    • Knowledge management

  • Ensure that adequate knowledge, regarding area of expertise, is shared as required and maintained within the research library
  • Provide advice and / or training as required
  • Maintain and develop specialist knowledge
  • Be a member of and make regular contributions to professional bodies, including publication of articles and research findings
  • Ensure CPD (continual professional development) or similar accreditation requirements are met annually to ensure maintained specialist accreditation

    • Network key relationships

  • Build and maintain an established network of internal (peers and executives) and external expert resources and partners
  • Represent the brand in professional networks

    • Operational environment

  • Responsible for identifying risks for department, maintaining the risk register and lowering the risk ratings

    • Specialist support to projects

  • Own Specialist knowledge in projects, when required
  • Conform to project management disciplines when participating in projects
  • Represent department or project on appropriate governance committees
  • Tender submissions
  • including drafting documentation, vetting documentation and doing costing of services
  • Implementation of strategic projects

    • Generic Objectives

  • Ensure all enhancements are successfully implemented in the organisation
  • Develop products that meet the defined quality requirements and that achieve the desired outputs / improvements
  • Identify operational and system weaknesses and implement refined processes, Standard Operating Procedures and systems
  • Manage Voice of the Customer Surveys and ensure action is taken to address issues, including process innovation
  • Business analysis and documentation of business plans for enhancements and developments
  • Liaison with business process specialists and project managers
  • Drive and oversee / ownership of projects for specific products
  • Cost containment :
  • Improve cost efficiency and reduce wasteful processes through the implementation of strategic projects
  • Manage a budget

    • Drive customer centricity :

  • Interfacing with 3rd parties and service provider networks

    • Operational environment :

  • Responsible for identifying risks for department, maintaining the risk register and lowering the risk ratings

    • Specialist support to projects :

  • Tender submissions
  • including drafting documentation, vetting documentation and doing costing of services
  • Implementation of strategic projects

    • Position Specific Outputs

    Business Acumen :

    Initiate and implement the strategies as determined by the respective strategic units and therefore requiring a thorough in-depth understanding and knowledge of the following operational areas :

  • Network Contract Management
  • Hospital & Facilities management
  • In-Hospital Case Management
  • Bureaus, Hubs and Switches
  • Pharmacy management
  • Business Partners, DBC, BASA, SASP, Workability etc.

    • Ensure that the pursuit of excellence and delivering on outstanding client centric service is paramount when delivering our services.

    Stakeholder Commitment :

  • Continuously drive to exceed needs of the Client (Scheme), Members, Service Providers (Doctors and Hospitals) as well as Business Partners.
  • Create long and lasting relationships that fully support all partners within the value chain.

    • Relationship Management :

  • Building, maintaining and managing relationships with stakeholders.
  • Monitoring business performance against targets.
  • Ensure effective communication processes are in place to address the requirements from key stakeholders.
  • Ensure that regular feedback meetings take place with stakeholders to identify gaps in the existing service model.
  • Drive continuous improvement through innovation.

    • People Management :

  • Develop and maintain productive and collaborative working relationships with peers and stakeholders.
  • Positively influence and participate in change initiatives.
  • Contribute to continuous innovation through the development, sharing and implementation of new ideas.
  • Facilitate and contribute to a culture which builds rewarding relationships, in line with the Medscheme values.
  • Empower teams to manage effectively.
  • Provide support and cultivate an environment that constantly strives for services excellence.
  • Cultivate an environment where staff are fully productive and training needs are identified and addressed

    • Knowledge

  • Understand and demonstrate agile development life cycles
  • Knowledge and application of relevant legislation

    • Skill

  • Ability to Develop, Guide and Direct liaison between various stakeholders
  • Competence to guide, direct sustainability productivity & cost effectiveness
  • High strategic level understanding of acquisitions and development opportunities
  • Principles and processes of clinical intervention in a structured environment
  • Support HRS medical strategy through product development and implementation
  • Communication Skills
  • Task Management
  • Executive Business Writing Skills
  • Quality driven
  • Innovates and Takes Risks
  • Change Management

    • The shortlisting process will only start once the application due date has been reached. The time taken to complete this process will depend on how far you progress and the availability of line managers.

    Our Commitment to Transformation

    AfroCentric is committed to transformation and embracing diversity. Our Employment Equity plan and targets will be considered as part of the recruitment process. This commitment is what drives us to achieve a diverse workplace with employment equity as a key goal to create an inclusive workforce, representative of the demographics of our society as well as people with disabilities.

    Should you not hear from us within a month of applying, consider your application unsuccessful .

    Seniority level

  • Mid-Senior level

    • Employment type

  • Full-time

    • Job function

  • Health Care Provider

    • Industries

  • Public Health

    • Referrals increase your chances of interviewing at AfroCentric Group by 2x

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