SUMMARY:
Plays a crucial role in maintaining positive relationships with healthcare providers.
POSITION INFO:
Job Title: Specialist Network Manager
Location:
Tshwane Metro, Pretoria, Brooklyn
Job Type:
Permanent, full-time hours
Primary Industry:
Health, Medical and related
Secondary Industry:
Insurance
Qualifications:
A relevant clinical or business related ND or Bachelor degree
Skills:
- Identify, evaluate and recruit healthcare providers with special emphasis on specialists
- Conduct market analysis to identify potential gaps in the network
- Negotiate provider contracts with associated remuneration tiers and service level agreements
- Collaborate with legal and compliance teams to ensure contracts align with regulatory requirements
- Serve as a primary point of contact for providers facilitating effective communication and collaboration
- Participate in the profiling process and meetings and assist with the claims monitoring process
- Evaluate the performance of healthcare providers to ensure adherence to quality and standards
- Stay informed with relevant healthcare regulations and accreditation standards
- Ensure adherence to all Medihelp policies guidelines and directives
- Utilise data analytical tools to assess network performance, identify trends, and make data-driven decisions
- Prepare regular reports on key performance indicators and present findings to leadership team
- Collaborate with Marketing and Member Administration teams to develop educational materials for members
- Manage budget and ensure no deviations
- Ensure constant operational efficiency through incremental innovation within the scope of work
Job Duties:
The Specialist Network Manager is responsible for identifying, evaluating, and recruiting healthcare providers with a special emphasis on specialists. They conduct market analysis to identify potential gaps in the network, negotiate provider contracts, and collaborate with legal and compliance teams to ensure regulatory compliance. The Specialist Network Manager serves as a primary point of contact for providers, evaluates provider performance, stays informed on healthcare regulations, and ensures adherence to company policies. They utilise data analytical tools to assess network performance, prepare reports, and collaborate with other teams to develop educational materials for members. Additionally, the Specialist Network Manager manages the budget, ensures operational efficiency, and drives incremental innovation within their scope of work.
Experience:
At least 7 years of experience in healthcare provider network management, within the context of medical schemes or health insurance
Knowledge and Skills:
- Strong understanding of healthcare provider networks
- Excellent negotiation and communication skills
- Ability to analyse data and make data-driven decisions
- Familiarity with healthcare regulations and accreditation standards
- Project management skills
Working Conditions:
The Specialist Network Manager works in an office setting, collaborating with various teams within the company. Occasional travel may be required to meet with healthcare providers or attend conferences.
Closing date: 26 July 2024
