About the position
Introduction
Internal Advert - Manager: Ambulatory Benefits Management
The position of Manager: Ambulatory Benefits Management is vacant. The Manager: Ambulatory Benefits Management will report directly to the Senior Manager Clinical Risk Management and form part of the Healthcare Management Division. The position is based at GEMS Head Office in Pretoria.
The total remuneration package will be R1 456 304 per annum, negotiable based on qualifications and experience.
The closing date for applications will be Tuesday, 10 February 2026.
Duties & Responsibilities
The Manager: Ambulatory Benefits Management will be required to provide support to the Senior Manager Clinical Risk Management through the implementation of the following Key Performance Areas (KPAs):
- Support the Scheme's strategic objectives and mandates in developing and implementing GEMS Clinical Risk-Ambulatory and Preventative Care Management Platform.
- Provide support to the Senior Manager for effective oversight of all the Scheme's Clinical Risk and Utilisation Management Programmes in the following defined areas:
o HIV and AIDS disease management,
o All chronic disease management programmes (incl. Oncology and Renal),
o High Risk Beneficiary programme,
o Ambulatory Value-Based Care Programmes,
o All pilot projects associated with Clinical Risk-Ambulatory Management,
o Chronic Back and Neck Rehabilitation Programme,
o Preventative and screening benefits, and
o Other programmes and projects as defined and aligned to the Scheme Strategy.
- Manage, set-up, and drive the Ambulatory Benefits Management programmes internally and externally with the GEMS Service Provider Network (SPN).
- Manage service providers to ensure the Scheme's Ambulatory Benefits Management Programmes are effectively and efficiently managed.
- Ensure that all risk areas applicable to Clinical Risk and utilisation management are identified, communicated, and strategies are put in place to mitigate risk.
- Drive Clinical Risk Management efficiency to deliver clinically approved and evidence-based quality outcomes.
- Ensure all CMS circulars are responded to and timeously implemented.
- Review and maintain an updated PMB and CDL lists.
- Participate in interdisciplinary committees within the Scheme.
- Manage people, processes, and systems internally and externally with SPNs where necessary; and
- Ensure compliance with CMS regulations.
Desired Experience & Qualification
Minimum requirements are:
- A degree or diploma in Health Sciences.
- A Certificate in Clinical Risk Management or Emergency Response will be an added advantage.
- Project Management certification (e.g., PMP) is an advantage.
- At least 5-7 years of experience in public health, primary healthcare (PHC), epidemiology, or disease risk management (chronic diseases, oncology, renal and preventative and screening, HIV/AIDS management.
- Minimum 5 years of work experience in the managed care or medical aid industry, with at least 2 years as a Manager/Supervisor in clinical risk management.
- Experience in managing outbreak response or emergency preparedness programs.
- Proven experience in engaging with public health institutions and global health entities (e.g., WHO, CDC);
- Epidemiological modelling and statistical analysis will be an added advantage.
- Primary Healthcare and Ambulatory benefits value-based care (VBC) program implementation and management.
- Must be in possession of a valid driver's license and own vehicle and be willing to travel at short notice.
- Knowledge of relevant legislation and industry norms, including but not limited to Prescribed Minimum Benefits and Clinical Coding.
Skills and Behavioural Competencies:
- Stakeholder engagement.
- Decision-making under pressure.
- Project management.
- Strategic planning.
- Data interpretation and reporting.
- Quantitative data analytics and critical thinking skills.
- Be organised and have good time management skills.
- Have excellent written and verbal communication and interpersonal skills.
- Able to collaborate effectively in a team.
- Be computer literate at an advanced level.
Interested?
GEMS employs people with the highest level of integrity - submission to the appropriate pre-employment assessment is obligatory to be considered for the position.
Kindly note that the information provided on application of the position may be shared with a third party for vetting purposes and will be stored by GEMS for a period of 5 years.
Kindly note that information is required for Employment Equity Purposes and information gathered is strictly used according to the intended purpose of collection, unless there is a legal need or permission is granted from the applicant themselves to make use of it for other purpose
Should you wish to have your information removed from the GEMS database, kindly send a request in writing to [Email Address Removed] .
GEMS adopts a hybrid work model.
GEMS is guided by the principles of employment equity. Preference will be given to groups who are underrepresented in accordance with GEMS employment equity plan.
Successful candidates will be required to seek approval to conduct other work outside of GEMS.
GEMS Employees are required to conduct themselves in a manner that reflects the organisation's paramount values: Excellence, Member Value, Integrity, Innovation, and Collaboration.
