Job description
Reporting to the General Manager, Health Business the incumbent is responsible for the development and implementation of medical practice management practices at UAP Old Mutual aimed at providing leadership in the provision of healthcare to our members as well as managing costs and Healthcare outcomes.
The key objectives for this position are: –
Develop and implement a Managed Care strategy aimed at coordinating medical care to achieve good patient experience better treatment outcomes and reduced healthcare costs.
Manage contracts with service providers including developing innovative reimbursement options and positioning UAP as a partner to the providers.
Overseeing case management practices at UAP.
Provide leadership in developing metrics for measuring quality outcomes and obtain collaboration with service providers in meeting the set standards.
Provide leadership in utilization of clinical and claims data to develop innovative products and processes that provide competitive advantage to UAP in health insurance services.
Overall responsibility for managing chronic conditions and inpatient services cost outcomes.
Guiding the business in compliance to health regulations relating to health insurance
Academic/Professional Qualifications and experience
1st Degree in medicine/pharmacy together with post graduate qualifications in healthcare management/health systems management/health economics/MBA
At least 3 years’ experience in a health financing setting
Demonstrated knowledge of managed care practices
Business management training
Knowledge, Skills and Competencies
Strong leadership and management skills
Ability to work independently and build effective interpersonal relations
Bias towards innovation and development of new ideas in problem solving
Professionalism in dealing with both internal and external customers
Effective communication both written and verbal
Key result areas and performance indicators
Managed care strategy development
Healthcare cost metrics
Quality of care outcomes
Patient experience metrics
Health service providers engagement and coordination
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