Specialist: Healthcare Provider Networks

The Road Accident Fund’s mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.

Purpose of the Job: Reporting to the Manager: Medical Policy and Research, the successful incumbent is accountable to manage the operations of healthcare provider networks.

Key Performance Areas

Manage Healthcare Provider Network Processes

• Monitor and manage the quality of healthcare Provider Performance Networks and compliance in line with the SLA or MoU.
• Provide orientation, education, and general support for existing providers which includes conducting all face-to-face meetings and ad-hoc requests.
• Responsible for establishing and maintaining processes and systems to provide routine services to members including contract management.

Provider Administration

• Design database systems used to manage provider data.
• Resolve escalated issues arising from operations and requiring coordination with other departments.
• Design and execute on performance management processes to demonstrate network performance.

Policy Review and Implementation

• Contribute to the development and implementation of healthcare Network protocols.
• Contribute to the development and implementation of provider networks.
• Keep up to date with effective SOP’s, policy and practice execution strategies.

Reporting

• Develop reports/ policies/ procedures and guide the process through the alignment of the documents to the overall RAF’s Strategy.
• Develop functional reporting systems, for management, projects or performance reporting.
• Prepare proposals, briefings, presentations, reports, and other documentation and provide management information both verbally and in report format.

Stakeholder Management

• Facilitate and manage communication with relevant internal and external stakeholders to proactively and progressively manage the relationships.
• Manage relationships with vendors, service providers or procurement teams and ensure that all relevant procured items are invoiced and paid on time.

Qualifications and Experience

• Bachelor’s Degree/ Advanced Diploma in Clinical Sciences related qualification.
• Relevant 5 - 7 years’ work experience in the healthcare funding/ medical scheme industry of which 3 - 5 years’ experience in healthcare networks and/or provider relations is essential.

Technical and Behavioral Competencies Required

• Resilience.
• Network and alliance.
• Employee engagement.
• Ethics and values.
• Change management.
• Critical and innovative thinking
• Policy conceptualisation and formulation.
• Risk Management.
• Stakeholder development and relations.
• Reporting.
• Good clinical acumen.
• Knowledge of medical information systems and processes.
• Knowledge of clinical technology and trends.
• Clinical Strategy development and execution.
• Understanding of health technologies.
• Knowledge of impairment rating procedures.
• Knowledge of relevant clinical legislation.

NB: “RAF offers Total Employment Cost packages with no additional contributions from the Employer, successful candidates are required to structure their packages in a manner that will suit their needs”.

The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.

Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful

Security Vetting shall be conducted on all prospective employees

It is the applicants’ responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.