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GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS)
 

​SENIOR MANAGER: HEALTHCARE NETWORKS AND PROVIDER RELATIONS
  • Pretoria
  • Permanent
  • Full Time
  • R 1 911 263 p/a.
  • EE/AA
 
Introduction
Job Advert – Senior Manager: Healthcare Networks and Provider Relations.
The position of Senior Manager: Healthcare Networks and Provider Relations is vacant. The Senior Manager: Healthcare Networks and Provider Relations will report directly to the Chief Healthcare Officer and form part of the Healthcare Management division. The position is based at Head Office, Pretoria.
The total remuneration package will be R1 911 263 per annum, will based on qualifications and experience.
The closing date for applications will be Tuesday, 31 December 2024.
 
Duties & Responsibilities
The Senior Manager: Healthcare Networks and Provider Relations will be required to support the Chief Healthcare Officer through the implementation of the following Key Performance Areas (KPAs):
1. Support the CHO in the oversight and execution of all activities related to the management of the Scheme’s healthcare networks:
  • Primary Healthcare Networks
  • Specialist Networks
  • Renal Dialysis Network
  • Hospital Networks
  • Pharmacy Network
  • Manage all healthcare network to ensure compliance, quality and cost efficiencies are maintained in line in line with contractual agreements.
  • Manage the Scheme’s Network Provider Upskilling and Training programme and budget in line with Scheme policy.
  • Oversee the management of- and support other scheme divisions in their provider relations and network management activities.
2. Support the CHO in the oversight and execution of all activities related to:
  • The Scheme’s Healthcare Provider Relations; and
  • The Scheme’s Provider Liaison Officer (PLO) Programme.
  • Proactively engage and maintain sound relationships with identified healthcare provider groups (hospital groups, pathologist groups, primary care practitioner societies, specialist societies, pharmacy groups, and other providers) on relevant strategic matters.
  • Participate in various stakeholder engagements (symposiums, summits, conferences, round tables, etc.) as delegated by the Chief Healthcare Officer.
  • Manage the Scheme’s provider relations and sponsorship budget in line with Scheme policy.
  • Oversee all activities related to the Scheme’s Provider Relations Officer (PLO) Programme.
  • Implement and manage the rollout of the Scheme’s PLO function across all the country's regions.
  • Establish sound mechanisms to enhance and integrate provider relations and network management services.
3. Support the CHO in the implementation of the Scheme’s strategic initiatives.
4. Continuously monitor the healthcare landscape and implementing innovative initiatives to improve member value.
5. Manage the end-to-end process of designing, planning, implementing, and maintaining comprehensive standard operating procedures and policies.
6. Perform program and project management functions for the Healthcare Management Division, including developing, implementing, and monitoring strategic and operational work plans.
7. Ensure that all Scheme’s functions align with the Medical Schemes Act, Scheme Rules, and other Legislation.
 
Desired Experience & Qualification
Qualification requirements are:
  • At least a 3-year diploma or degree in Clinical Sciences (medical/ nursing/ physiotherapy/psychology, etc.) and other relevant/ equivalent qualifications.
  • Minimum 7 years of work experience in the healthcare funding/ medical scheme industry.
  • Minimum 5 years as Manager/Supervisor in the healthcare funding/ medical scheme industry.
  • Must have experience in provider network and relationship management.
  • Must have a good understanding of the Medical Schemes Act.
  • Must have excellent computer literacy and Microsoft Office skills.
  • Must be able to analyse qualitative and quantitative data.
  • Must have excellent communication and writing skills.
  • Must have planning and project management skills.
  • Must be able to pay attention to detail and be a self-starter.
  • Must have the ability to work well as part of a team.
  • Must have a valid driver’s license, own a vehicle, and be willing to travel at short notice.
  • Must understand all healthcare coding (Nappi, Tariffs, ICD10, CPT4, UPFS) and more.
  • Must have good organisational skills and be able to meet tight deadlines.
  • Must have a good understanding of the South African healthcare system.



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Interested?
The closing date for applications is 31 December 2024. 
Should you not hear from us by 31 March 2025, please consider your application unsuccessful.
GEMS employs people with the highest level of integrity – submission to the appropriate pre-employment assessment is obligatory to be considered for the position.
Kindly note that the information provided on application of the position may be shared with a third party for vetting purposes and will be stored by GEMS for a period of 5 years.
Kindly note that information is required for Employment Equity Purposes and information gathered is strictly used according to the intended purpose of collection, unless there is a legal need or permission is granted from the applicant themselves to make use of it for other purpose.
 
Should you wish to have your information removed from the GEMS database, kindly send a request in writing to jobs@gems.gov.za.
 
GEMS adopts a hybrid work model.
GEMS is guided by the principles of employment equity. Preference will be given to groups who are underrepresented in accordance with GEMS employment equity plan.
Successful candidates will be required to seek approval to conduct other work outside of GEMS.
GEMS Employees are required to conduct themselves in a manner that reflects the organisation's paramount values: Excellence, Member Value, Integrity, Innovation, and Collaboration.