Description:
Job Title:Clinical Risk Manager
Location:
Sandton
Industry:
Medical and Health Insurance
Hire Resolve's Client is seeking to hire a Clinical Risk Manager to join their team in Bryanston, Sandton. The Clinical Risk Manager oversees clinical risk and utilisation management, ensuring cost-effective, evidence-based care. The role includes leading a clinical team, identifying and addressing risks or fraud, and engaging stakeholders to optimise patient outcomes and service efficiency.
Responsibilities:
- Develop, implement, and maintain clinical risk management frameworks, policies, and procedures
- Resolve complex customer service issues escalated from junior staff
- Manage and develop direct reports, ensuring key performance indicators are achieved
- Oversee departmental milestones, adapting to evolving business needs
- Lead and manage a team of Clinical Case Managers, Disease Management Specialists, and Nurses
- Provide mentorship, coaching, and training to enhance team performance and decision-making
- Conduct performance reviews and implement staff development plans
- Ensure departmental standards are maintained and service levels remain high
Requirements:
- Matric / Senior Certificate
- Registered Nursing Diploma
- Valid membership with the South African Nursing Council (SANC)
- Claims and Forensic Risk Management Certification
- Registration with the Association of Certified Fraud Examiners (ACFE SA)
- FAIS compliant or significant progress towards compliance (advantageous)
- Minimum of 4 years’ experience in provider utilisation and fraud management
- Proven experience in leading and managing clinical teams
- Experience within a managed care or health insurance environment
- Deep understanding of South Africa’s healthcare landscape, legislation, and opportunities
- Strong interpersonal skills to effectively engage with stakeholders, providers, clinicians, and members
- Strong analytical and problem-solving abilities with keen attention to detail
- Excellent judgment, negotiation, and decision-making skills
- High ethical standards and professional integrity
- Ability to manage a multidisciplinary clinical team proactively
- Proficient in MS Office and computer literate
- Knowledge of evidence-based medicine and health economics principles
- Ability to manage multiple priorities and make informed clinical decisions under pressure.
How to Apply:
- Contact Hire Resolve today for your next career-changing move
- Our client is offering a highly competitive salary for this role based on experience.
- Send your CV to: financialcareers@hireresolve.za.com or connect with Mischa Bornman via LinkedIn.
- Alternatively, you can also contact me directly at Hire Resolve mischa.bornman@hireresolve.us
- We will contact you telephonically in 3 days should you be suitable for this vacancy. If you are not suitable, we will put your CV on file and contact you regarding any future vacancies that arise.
Requirements:
Job Title:Clinical Risk Manager
Location:
Sandton
Industry:
Medical and Health Insurance
Hire Resolve's Client is seeking to hire a Clinical Risk Manager to join their team in Bryanston, Sandton. The Clinical Risk Manager oversees clinical risk and utilisation management, ensuring cost-effective, evidence-based care. The role includes leading a clinical team, identifying and addressing risks or fraud, and engaging stakeholders to optimise patient outcomes and service efficiency.
Responsibilities:
- Develop, implement, and maintain clinical risk management frameworks, policies, and procedures
- Resolve complex customer service issues escalated from junior staff
- Manage and develop direct reports, ensuring key performance indicators are achieved
- Oversee departmental milestones, adapting to evolving business needs
- Lead and manage a team of Clinical Case Managers, Disease Management Specialists, and Nurses
- Provide mentorship, coaching, and training to enhance team performance and decision-making
- Conduct performance reviews and implement staff development plans
- Ensure departmental standards are maintained and service levels remain high
Requirements:
- Matric / Senior Certificate
- Registered Nursing Diploma
- Valid membership with the South African Nursing Council (SANC)
- Claims and Forensic Risk Management Certification
- Registration with the Association of Certified Fraud Examiners (ACFE SA)
- FAIS compliant or significant progress towards compliance (advantageous)
- Minimum of 4 years’ experience in provider utilisation and fraud management
- Proven experience in leading and managing clinical teams
- Experience within a managed care or health insurance environment
- Deep understanding of South Africa’s healthcare landscape, legislation, and opportunities
- Strong interpersonal skills to effectively engage with stakeholders, providers, clinicians, and members
- Strong analytical and problem-solving abilities with keen attention to detail
- Excellent judgment, negotiation, and decision-making skills
- High ethical standards and professional integrity
- Ability to manage a multidisciplinary clinical team proactively
- Proficient in MS Office and computer literate
- Knowledge of evidence-based medicine and health economics principles
- Ability to manage multiple priorities and make informed clinical decisions under pressure.
How to Apply:
- Contact Hire Resolve today for your next career-changing move
- Our client is offering a highly competitive salary for this role based on experience.
- Send your CV to: financialcareers@hireresolve.za.com or connect with Mischa Bornman via LinkedIn.
- Alternatively, you can also contact me directly at Hire Resolve mischa.bornman@hireresolve.us
- We will contact you telephonically in 3 days should you be suitable for this vacancy. If you are not suitable, we will put your CV on file and contact you regarding any future vacancies that arise.
- Develop, implement, and maintain clinical risk management frameworks, policies, and procedures
- Resolve complex customer service issues escalated from junior staff
- Manage and develop direct reports, ensuring key performance indicators are achieved
- Oversee departmental milestones, adapting to evolving business needs
- Lead and manage a team of Clinical Case Managers, Disease Management Specialists, and Nurses
- Provide mentorship, coaching, and training to enhance team performance and decision-making
- Conduct performance reviews and implement staff development plans
- Ensure departmental standards are maintained and service levels remain high
- Matric / Senior Certificate
- Registered Nursing Diploma
- Valid membership with the South African Nursing Council (SANC)
- Claims and Forensic Risk Management Certification
- Registration with the Association of Certified Fraud Examiners (ACFE SA)
- FAIS compliant or significant progress towards compliance (advantageous)
- Minimum of 4 years’ experience in provider utilisation and fraud management
- Proven experience in leading and managing clinical teams
- Experience within a managed care or health insurance environment
- Deep understanding of South Africa’s healthcare landscape, legislation, and opportunities
- Strong interpersonal skills to effectively engage with stakeholders, providers, clinicians, and members
- Strong analytical and problem-solving abilities with keen attention to detail
- Excellent judgment, negotiation, and decision-making skills
- High ethical standards and professional integrity
- Ability to manage a multidisciplinary clinical team proactively
- Proficient in MS Office and computer literate
- Knowledge of evidence-based medicine and health economics principles
- Ability to manage multiple priorities and make informed clinical decisions under pressure.
- Contact Hire Resolve today for your next career-changing move
- Our client is offering a highly competitive salary for this role based on experience.
- Send your CV to: financialcareers@hireresolve.za.com or connect with Mischa Bornman via LinkedIn.
- Alternatively, you can also contact me directly at Hire Resolve mischa.bornman@hireresolve.us
- We will contact you telephonically in 3 days should you be suitable for this vacancy. If you are not suitable, we will put your CV on file and contact you regarding any future vacancies that arise.
13 May 2025;
from:
careers24.com