PROVIDER NETWORK MANAGER – CIMAS 396 views

Job Summary
The Group wishes to invite applications from suitably qualified & experienced individuals to fill in the Provider network manager role that has arisen in our organization.

To develop and maintain relationships with Service Providers in line with Cimas Health Group Strategic goals and objectives, and to develop, maintain, and ensure implementation of Cimas medical aid tariffs after research, comparisons, and data analytics.

Duties And Responsibilities
Develops the Annual Operating Plan for the Department.
Oversees the identification and development of relationships with Service Providers in collaboration with the Medical Advisor and Head of Clinics in line with the Group’s goals and objectives.
Analyses trends in service provider behaviors and aligns with service providers whose practices are beneficial to Cimas members.
Engages with Service Providers on matters arising from the use of the tariffs and interaction with Cimas members.
Informs internal and external members, stakeholders, regulators and similar regarding Cimas relevant communications and business conditions.
Updates and improves the framework for the preferred service provider network to ensure correct registration, accreditation, good outcomes and informs the Managed Care staff accordingly.
Ensures that the Risk and Compliance requirements are followed in line with the relevant SOP’s.
Ensure there are systems in place to coordinate monitoring and follow-up of recommendations from internal and external audits.

Qualifications And Experience
Bachelor’s degree of Medicine and Surgery.
Master’s degree in Communications & Public Relations or a Master’s degree in Business Administration an added advantage.
5-8 years experience in a healthcare service organization with knowledge of healthcare financing, management and implementation.
Holder of a valid Practicing Certificate with MDPCZ
Member of either ZIMA, CPCPZ or relevant specialist body
Ability to identify, communicate and ensure implementation of the agreed business objectives for the relevant unit.
Excellent verbal and written communication and able to clearly present complex situations
Ability to plan and organize medium to long-term objectives.