Job Description

THE JOB AT A GLANCEAs 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 timeThe 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.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.

Rand Mutual