Clinical Service Manager

Recruiter:

Solicited

Job Ref:

JHB000090/Zoe

Date posted:

Wednesday, August 10, 2022

Location:

Centurion, South Africa

Salary:

900 000 Annually

JOB SUMMARY:
We are recruiting a Clinical Service Manager to join in the Clinical and Operations Department at the Centurion Office. The successful candidate will adhere to supporting and monitoring the development and implementation of clinical protocols, management, and service strategies. Support the clinical & operations Executive to implement the Scheme’s strategy in a manner that supports healthcare quality and best practice standards.

JOB DESCRIPTION:

Responsibilities: Stakeholder Management/ Reporting and Governance Risk

Coordinate Quarterly and ad hoc meetings with Hospital groups and other healthcare providers
Investigate and provide high-level input into the resolution of escalated clinical queries from healthcare service providers
Coordinate and provide interdepartmental clinical support
Forge relationships with Clinical/Medical advisors contracted by the Scheme’s contracted Managed Care Organizations
Ensure that the relevant stakeholders are kept updated on any changes within the clinical services
Ensure adherence to the Scheme’s reporting requirements,
Identify trends and provide early warnings reports to line manager
Identify and escalate any concerns emanating from the reviewed reports, and provide recommendations on possible solutions
Review the clinical framework audit reports ensuring alignment with the clinical governance policy
Ensure adherence to internal policies and regulatory requirements
Assist in identifying, assessing, and mitigating risks
Provide input into the operational risk register

Strategy implementation and Clinical Services

Support implementation of Scheme’s strategy from a clinical services perspective Contribute to the development of the clinical strategy, in alignment with the organizational strategy
Assist in monitoring the implementation and performance of the clinical services strategy against the overall organizational strategy
Assist in monitoring the implementation of the clinical governance framework
Identify individual member needs from the reports, research, and other mediums, to improve on the benefits offered as well as the healthcare programs
Assist in developing plans to mitigate against negative member impact
Identify and escalate unresolved healthcare provider issues
Ensure that ex gratia payments are made in line with the relevant Scheme policy
Assist in the benefit design process
Assist in developing and/or updating clinical protocol, and funding guidelines based on the advances in the health industry and research
Keep abreast with advances in the healthcare industry locally and internationally

Requirements:

MBCHB or equivalent combination of education and job-related experience (NQF Level 7)
Registration with the Health Professions Councils of South Africa (HPCSA) is essential
Minimum of 5 years experience of which 3 years must be in the Medical Scheme /Healthcare Funding industry

If you meet the requirements for the above position, click on Apply button
To see more career opportunities visit
website: If you don’t hear from us within 2 weeks from the closing date, please consider your application unsuccessful. Should we have any other roles that match your profile, we will contact you.

NB! This job is now closed. You can apply for other jobs by uploading your CV.

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