Senior Specialist: Managed Care

Recruiter:

Liyema Consulting

Job Ref:

JHB002290/Laka

Date posted:

Wednesday, July 16, 2025

Location:

Pretoria, South Africa

SUMMARY:
Job Title: Senior Specialist – Managed Care
Location: Pretoria
Job Type: Onsite
Department: Clinical Services

Purpose of the Role:

To design, implement and monitor managed care strategies and programmes using healthcare data insights. The role supports optimal healthcare delivery through proactive risk management, strategic procurement, and the design of preventative, curative, and cost-effective care programmes.

POSITION INFO:

Key Responsibilities:

Analyse health data to stratify and segment member risk profiles.
Develop condition- and category-based care plans and intervention strategies.
Oversee healthcare risk management, including epidemic and chronic care response.
Implement and evaluate preventative care, curative care, and wellness programmes.
Manage hospital benefit interventions and ensure SLA targets are met.
Lead managed care implementation monitoring and stakeholder engagement.
Provide input on budgeting, forecasting, and cost control in managed care initiatives.

Minimum Requirements:

NQF Level 7 Degree in Nursing or Health-related field.
Minimum 6 years' experience in managed care.
Demonstrated experience with:
- Health data analysis
- Care programme design
- Stakeholder management
- Budget and SLA performance monitoring

Key Skills & Competencies:

Health Risk Assessment
Analytical thinking
Communication & Reporting
Project and Financial Management
Collaboration & Cultural Sensitivity
Governance and Compliance

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