Medical Operations Manager

SUMMARY:
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POSITION INFO:

E 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 YOU'LL BRING TO THE TABLE?
  Relevant clinical/ medical qualification in Nursing/ Nursing Science
  Experience in Managed Care and health management
  Client liaison

• SKILLS AND EXPERIENCE
• 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.

• 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
  The shortlisting process will only start once the advert due date has been reached. The time taken to complete this
  process will depend on how far you progress within the recruitment process and the availability of our
  managers. Kindly note that should you not receive a response within 21 days, please consider your application
  unsuccessful.
  Our Commitment to transformation:
  In accordance with the employment equity plan of Rand Mutual Assurance and its employment equity goals and
  targets, preference may be given, but is not limited, to candidates from under-represented designated groups.