Senior Specialist: Managed Care
Pretoria, Gauteng, South Africa
Job Description
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.
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.
- 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
- Health Risk Assessment
- Analytical thinking
- Communication & Reporting
- Project and Financial Management
- Collaboration & Cultural Sensitivity
- Governance and Compliance
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Job Detail
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Job IdJD1462766
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IndustryNot mentioned
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Total Positions1
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Job Type:Full Time
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Salary:Not mentioned
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Employment StatusPermanent
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Job LocationPretoria, Gauteng, South Africa
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EducationNot mentioned