Manager – Medical Operations (Parktown) at Rand Mutual - RMA

• 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.

Requirements
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.