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

Similar jobs you might be interested in:

Administrator: Y.E.S. (Youth Employment Service)
Location: Johannesburg
Salary:
Signa Opportunity is recruiting unemployed youth for quality workplace experience through the YouthEmployment Service (YES) initiative.About the YES InitiativeThe initiative was launched by the President in 2018 and is a partnership with the government and labourdepartment to collectively devise a national plan to build economic pathways for South Africa’s youth bycreating workplace opportun...
18 days ago

Medical Officer (FTC - Wits VIDA)
Location: Johannesburg
Salary: Monthly
Background:The Vaccines and Infectious Diseases Analytics (VIDA) Research Unit of the University of the Witwatersrand, formerly RMPRU (Respiratory and Meningeal Pathogens Research Unit) has for over 20 years conducted numerous studies to assess the burden of and prevent vaccine-preventable diseases (VPD).Current studies and projects include infant rotavirus and BCG trials
3 days ago

Learning & Development Specialist
Location: Pretoria
Salary:
Our client, a national manufacturing concern, currently seeks your Learning & Development experience to ensure the delivery of occupationally directed education, training and development to Line Managers and employees to improve the performance of individuals and effectiveness of the organisation.
3 days ago

Senior Specialist: Managed Care
Location: Pretoria
Salary:
Job Title: Senior Specialist – Managed CareLocation: PretoriaJob Type: OnsiteDepartment: Clinical ServicesPurpose 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...
3 days ago

Learning & Development Specialist
Location: Pretoria
Salary:
4 days ago

Technical Advisor (Healthcare - Wits RHI)
Location: Pretoria
Salary: Annually
Background:The Wits Reproductive Health and HIV Institute (Wits RHI) is a renowned African-led research institute that seeks solutions to Africa’s health challengesIt is located within the University of the Witwatersrand and addresses some of the greatest public health concerns affecting our region, including HIV and its related problems, sexual and reproductive health, and vaccinology
8 days ago

Managing Partner South Africa
Location: Johannesburg
Salary: Monthly
We are seeking a dynamic and entrepreneurial Managing Partner with deep expertise in the Learning & Development (L&D) environment to lead and scale L&D and executive education initiatives across the corporate and private sectors in South Africa and beyond. This strategic leadership role requires an individual with strong business acumen, a proven track record in L&D, and the abilit...
10 days ago

Intermediate Project Manager
Location: Pretoria
Salary:
Are you a dynamic and seasoned Project Manager ready to drive high-impact initiatives at the heart of corporate transformation?Our client, a leading organisation (in the banking industry) with a strong commitment to service excellence, is seeking an exceptional Project Manager to support and lead a key demand-driven programme within their Corporate Services division. This is a critical opportunity...
10 days ago

Technical and Programme Co-ordinator
Location: Garden Route
Salary:
Technical and programme Co-ordinatorWestern and Northern Cape (Based in or near Citrusdal)A leading agricultural solutions provider seeks a Technical and programme Co-ordinator to support their Sterile Insect Technique (SIT) programme in the Western and Northern Cape regions. This permanent role is ideally suited to a young Entomologist or a candidate with a relevant BSc qualification in agricultu...
11 days ago

Scrum Master
Location: Johannesburg
Salary:
Role Purpose:The Scrum Master will play a pivotal role in Project Athena, managing a cross-functional team that includes Business stakeholders, the companies IT experts, and Vendor resources. This team will configure and implement a short-term insurance product on a new Policy Administration System (PAS), enabling capabilities such as product configuration, process automation, workflow orchestrati...
12 days ago