Senior Specialist: Managed Care

Findojobs South Africa; Gauteng; On-site; ZAR 500,000 - 700,000; Full time

Job summary

A healthcare management company in Gauteng is seeking an experienced health professional to lead managed care initiatives. Responsibilities include analyzing health data, developing care plans, and overseeing risk management strategies. The ideal candidate will have a Level 7 Degree in Nursing or a related field, with at least 6 years of experience in managed care and a strong background in stakeholder management and health data analysis. This position offers a chance to make a significant impact on community health.

Qualifications

• Minimum 6 years' experience in managed care.
• Demonstrated experience with health data analysis, care programme design, stakeholder management.

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.

Skills

Health Risk Assessment

Analytical thinking

Communication & Reporting

Project and Financial Management

Collaboration & Cultural Sensitivity

Governance and Compliance

Education

NQF Level 7 Degree in Nursing or Health-related field

Job description

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