Managed Healthcare Manager (medically qualified)

Job Description

We are seeking an experienced Managed Healthcare Manager (Medically Qualified) to lead and oversee managed healthcare operations. The successful candidate will be responsible for managing clinical and healthcare funding functions, ensuring the delivery of high-quality managed healthcare services, regulatory compliance, and operational excellence within a managed healthcare or health insurance environment.

Minimum Requirements

• Bachelor's Degree or Advanced Diploma in Medicine, Nursing, Pharmacy, Clinical Sciences, or another Medical/Clinical-related qualification.
• Minimum of 5 years' experience in a Managed Healthcare and/or Health Insurance environment.
• Strong knowledge of managed healthcare principles, healthcare funding, and medical scheme operations.
• Sound understanding of healthcare legislation, clinical governance, and regulatory compliance.
• Experience in healthcare risk management, utilisation management, and provider relationship management.
• Strong leadership, stakeholder management, and decision-making skills.
• Proficiency in Microsoft Office and healthcare management systems.

Key Responsibilities

• Lead and manage managed healthcare operations to ensure efficient and effective service delivery.
• Develop and implement managed healthcare policies, procedures, and operational strategies.
• Oversee clinical risk management, utilisation management, and case management activities.
• Monitor healthcare service quality and ensure compliance with regulatory and contractual requirements.
• Collaborate with healthcare providers, medical practitioners, and other stakeholders to improve healthcare outcomes.
• Analyse healthcare utilisation trends and recommend cost-containment and quality improvement initiatives.
• Manage provider networks and support contract performance monitoring.
• Prepare operational and management reports, including healthcare performance metrics.
• Lead and mentor multidisciplinary teams to achieve organisational objectives.
• Drive continuous improvement initiatives to enhance healthcare service delivery and operational efficiency.

Preferred Skills

• Managed Healthcare Management
• Healthcare Funding and Medical Schemes
• Clinical Governance
• Utilisation Management
• Case Management
• Healthcare Risk Management
• Regulatory Compliance
• Stakeholder and Provider Relationship Management
• Leadership and People Management
• Strategic Planning and Performance Management

How to Apply

If you meet the above requirements and have the relevant experience, click Apply Now to submit your updated CV together with your qualifications and proof of professional registration (where applicable).

Only shortlisted candidates will be contacted**.**

Work Location: In person