Job Description

Job SummaryE 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.Business Capital GroupRecruiter

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