Executive Managed Healthcare - Centurion at PPS

Job Advert Summary    

• To support the CEO by providing strategic direction aimed at enhancing broader access of the organisation’s products and services to members of medical aid schemes, to address the sustainability needs of clients through the managed care strategy, as well as ensure that the organisation is a key player in the provision and delivery of managed healthcare services through forging close ties with key stakeholders.
• Managing the achievement of all managed healthcare targets for defined areas within the full spectrum of managed healthcare services sought by clients in the health insurance market.
• To provide new and innovative managed healthcare solutions within the health insurance industry
• To contribute to the increase of profitability of the organisation by effectively planning, organising, leading & controlling operations thereby also ensuring that the existing business is maintained
• To maintain responsibility and strategic direction for the provider and analytics functions
• To support clients schemes in their benefit design processes
• Ensure that contractual service levels across the functions described above are met
• Lead clinical meetings for client schemes as well as attend special committee meetings
• Lead business development and revenue generation opportunities for the business
• Understanding of digital landscape and the use of technology to improve access and lower cost.

Minimum Requirements    

• Healthcare Degree
• Leadership/ Business Qualification (NQF level 8) advantageous
• It is a requirement of the organisation for the incumbent to consistently enhance his /her development by taking ownership of his/her learning and to keep abreast of changes within the Health insurance industry and the global village at large.

Minimum Experience :

• 3 – 5 years executive management experience essential
• Successful track record in a managed healthcare environment advantage.
• Experience in designing revenue generating solutions
• Good knowledge of contractual agreements and legal alignments thereof, an advantage.
• Member of appropriate professional medical bodies e.g. SAMA, SAPC, SANC etc
• Good knowledge of the Medical Schemes Act No. 131 of 1998 preferred.
• Clinical protocol development disease management experience essential .

Duties and Responsibilities    

• Continuously contribute to the evaluation and development of organisational strategy and performance in co-operation with the executive team.
• Plan, develop & implement strategy for operational management & development so as to meet agreed organisational performance plans within agreed budgets and timescales (covering relevant areas of operation i.e. Clinical Risk/ Medicine Management/ Disease Management/ Preauthorisation/ Case Management/ Wellness Programmes and Medical Underwriting).
• Establish and maintain appropriate systems for measuring necessary aspects of operational management and development.
• Monitor, measure and report on operational issues, opportunities and development plans and achievements within agreed formats and timelines.
• Manage and develop direct reporting staff.
• Manage and control organisational expenditure within agreed budgets.
• Liaise with other functional business unit managers so as to understand all necessary aspects and needs of operational development, and to ensure that they are fully informed of operational objectives, purposes and achievements.
• Maintain awareness and knowledge of organisational strategy and provide suitable interpretation to managers and staff in the organisation thereby ensuring successful implementation thereof.
• Be aware and act on all opportunities for increasing the client base and obtaining new business.
• Establish profitable relationships with new and existing clients.
• Ensure activities meet with and integrate with organisational requirements for quality management, health and safety standards, legal stipulations, environmental policies and general care of duty.
• Execute responsibilities according to lawful and ethical standards in alignment with PPS Healthcare Administrators’ Code of Ethics.
• Remain aware of competitor products and activities relevant to maximising revenue.
• Remain abreast of market trends and give feedback to the CEO.
• Deliver the highest standards of customer service through management to achieve business, improve long-term customer retention and secure referral business.
• Assist in medical scheme product development and benefit design.
• Manage and develop core product diversification.
• Assist and compliment the efforts of the Client Principal Officers in the areas related to care coordination and managed care for scheme members.
• Adhere to and demonstrate PPS Healthcare Administrators’ value proposition:
• We are eternally curious: Question it
• We take extreme ownership: Own it
• We do the right thing: Do it right