GM: Operations (Medical Doctor) Medical Aid Administrator

The Operations Director oversees all operational aspects of company strategy, helps set strategic goals and is responsible for the flow of operations information to the Managing Director and the Board. The incumbent will also be responsible to manage inter-departmental processes, where such processes are part of the administrative functions.Duties: Interacting with Managers and Senior Managers of different areas of the organisation with the view to align, optimise and integrate business processes and service delivery.Ensuring that the Company strategic objectives are managed and met with continuous improvement of the customer’s experience.Drive and ensure the effective design, implementation, and monitoring of special projects, based on key trends.Lead and ensure that the Managed Care team provide effective implementation support on special projects.Ensure compliance with Council for Medical Scheme’s accreditation requirements for manage care organisation.Lead the conceptualising of the Managed Care risk register in consultation with the Director - Group Legal Affairs, Risk and ComplianceEnsure the mitigation of the division’s risk profile through the application of fraud controls and risk prevention principles and implementing of sound governance and compliance processes and tools to identify and manage risks.Administer company’s guidelines for managed care contracting and compliance.Oversees and participates in the development, negotiation, implementation, monitoring, and management of all managed care agreements.Create and participate in initiatives to grow the Group’s customer base and to retain existing clients.Ensure managed care deliver measurable value to clients which includes cost savings, quality care (patient outcomes) and access to care.Ensure that all interventions are evidence-based, patient-specific and delivered with a caring approach.Managing, motivating and up-skilling the operations team, developing and growing the team through formal training, mentoring, and coaching and skills development.Drive daily monitoring and analyses of the manage care business processes and performance.Drive business optimisation to reduce administrative costing whilst maximising profitability.Ensure Continuous improvement of current operational processes in line with best practise.Participate in identify new business opportunities and play a key role in preparing tenders for the managed care division.Monitor and oversee compliance with audit control system procedures and policy, comply with legal requirements and meet all safety standards.Assist with special projects and assignments and take on any other management responsibilities not specifically identified above on an as needed basis.Ensures that the working environment contributes to improve staff well-being.Managing day-to-day activities across all managed care functions.

Requirements

Grade 12/MatricA South African born, qualified Doctor (HPCSA)A post graduate qualification will be advantageousA minimum 5 years’ Senior Management experience in providing Managed Care services in the medical aid scheme industry in South AfricaExperience with ISO9001 certification process to manage the quality assurance programme for the division.Strong verbal and written communication skills