Senior Specialist: Managed Care

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

Purpose of the Role:

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