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Che Leigh Personnel Consultants

MANAGER HOSPITAL RISK MANAGEMENT at MEDICAL SCHEME

Che Leigh Personnel Consultants

  • Undisclosed
  • Permanent Management position
  • Bryanston
  • Posted 07 Jul 2025 by Che Leigh Personnel Consultants
  • Expires in 34 days
  • Job 2615977
Apply Now

About the position

Operational oversight of clinical risk, quality, and staff performance within the Hospital Risk Management department which includes pre-authorisation case management and clinical auditing.
Strategic leadership to drive continuous improvement, cost efficiency, innovation, and alignment to the Scheme's overall managed care strategy.

Key Performance Areas (KPAs)

  • Responsible for the design, development, implementation and monitoring of all hospital-based risk management to improve access to and ensure high-quality, cost-effective management of entire hospital incidents.

  • Promote a culture of accountability and professionalism, while developing systems, policies, and initiatives that proactively reduce clinical

KEY RESPONSIBILITIES

Clinical and Risk Management

  • Lead continuous clinical, medical, and surgical risk evaluations, and report to the Scheme and company.
  • Participate in the Clinical Review Team to support scheme and medical advisor decision-making.
  • Stay current with clinical knowledge and new treatment modalities.
  • Develop and implement clinical protocols, guidelines, and processes that drive quality and performance.
  • Liaise with healthcare providers, scheme networks, and external stakeholders to manage member care pathways and mitigate clinical risks.
  • Occasionally accompany case managers for onsite reviews of complex, high-risk cases.
  • Analyse claims data and audit results to recommend targeted interventions that reduce fraud, waste, and abuse.
  • Respond to Council for Medical Schemes (CMS) member complaints related to the department

Product & Scheme Development

  • Assist with the conceptualisation, planning, and implementation of new managed care products.
  • Contribute to medical scheme product development and benefit design.
  • Stay abreast of industry developments, healthcare legislation, and regulatory requirements.
  • Participate in tariff negotiations with hospital groups.
  • Liaise with the Principal Officer and Medical Advisor for clinical alignment and strategic decision making

Operational Management

  • Oversee day-to-day departmental operations and address operational inefficiencies.
  • Ensure alignment of departmental performance with scheme sustainability goals and budget targets.
  • Monitor and evaluate internal and external communication flows.
  • Manage internal processes for confidential staff admissions, including pre-authorisation and appropriate claims payment.
  • Coordinate weekly, monthly, and quarterly reports to business, schemes, and external hospital groups.
  • Ensure adherence to SLAs and other compliance metrics.

Process Improvement & Systems

  • Oversee the management and review of clinical SOPs, training manuals, and workflow documentation.
  • Lead the implementation of new systems and process enhancements (e.g., IMed, Curus, Workflow, Billing Rules).
  • Collaborate with Business Liaison and IT on system improvements; responsible for user testing and sign-off.
  • Project manage new initiatives and enhancements from planning through to execution, including training and change management.

Leadership & People Management

  • Provide coaching, mentoring, performance management, and quality control for team members.
  • Drive a culture of accountability, professionalism, and service excellence.
  • Manage staff KPAs, conduct quality control feedback sessions, and support disciplinary processes where necessary.
  • Identify and develop talent through succession planning and continuous professional development.

QUALIFICATIONS AND EXPERIENCE

  • Registered Nurse or Pharmacist
  • A Minimum of 5-7 years experience in managed healthcare, hospital management clinical governance or medical scheme operations
  • 3 years in a management or leadership role with experience managing clinical teams and driving strategic initiatives
  • Legislation relating to the work of medical schemes
  • A valid drivers licence is essential

Desired Skills:

  • Registered Nurse or Pharmacist
  • extensive experience within managed healthcare
  • strong management skills
  • extensive knowledge of hospital risk management within the medical schemes industry

Apply Now

Che Leigh Personnel Consultants

About the agency

A professional agency with over 20 years experience in the Recruitment industry. We place people across the board with a strong emphasis in Healthcare, Financial Services and Legal.

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