ROLE PURPOSE
Accountable for the implementation of tactical work plans and formulate associated procedures to minimise the financial risk of the Company by implementing, maintaining and improving the defined care programs with special emphasis on hospital benefit management; providing clinical support for maintaining the acceptable level of quality and hospital risk measures.

KEY AREAS OF RESPONSIBILITY
- Provide input into the development of the sub-division’s strategy.
- Develop a supporting tactical plan for the Clinical Risk sub-division to ensure execution of the strategic objectives and goals.
- Drive the implementation of the tactical plan by developing and allocating operational activities, and ensuring alignment to the achievement of operational targets.
- Ensure the establishment, maintenance and improvement of Standard Operating Procedures, policies, and guidelines relating to the Clinical Risk sub-division in consultation with the Executive: Operations.
- Use insights gained through business information to compile reports, and metrics to measure success, inform the business decision-making process, and realign objectives.
- Monitor and continuously evaluate progress of the sub-division’s achievements against the tactical plan and strategic objectives.
- Investigate and provide high level input into the resolution of escalated queries received from the Operations division and third party managed care organisations to ensure effective feedback to members and in accordance with set SLA.
- Identify and target cost drivers in the company's healthcare expenses.
- Develop and implement a plan to manage and monitor the return on investments of recommended and/or approved networks.
- Develop and maintain performance measures for third party services in accordance to agreed SLA.
- Provide input into the department’s risk register in consultation with the Manager: ARC.
- Ensure the mitigation of the department’s risk profile through the application of fraud controls and risk prevention principles and implementing of sound governance and compliance processes and tools to identify and manage risks.
- Responsible for the coordination and maintenance of quality risk management in line with the requirements from ISO9001:2015.
- Monitor changes in the regulatory environment and ensure that appropriate operational controls are implemented to address new requirements.
- Support and provide evidence to internal, external and ISO audit requirements.
- Oversee the maintenance and enforcement of all clinical risk related Service Level Agreements to minimise business risk and ensure business continuity.
- Ensure adherence in the Clinical Risk team to all relevant laws, policies and Standard Operating Procedures throughout the organisation.
- Provide input in the planning and compilation of the department’s annual budget aligned to the tactical delivery plans to support the implementation of set objectives.
- Ensure the effective implementation, management, monitoring of the department’s budget, and mitigate and report on any variances.
- Ensure the deployment of proper financial controls to manage the departmental budget.
- Report on and communicate any costs improvements and shortfalls.
- Build and lead an effective and cohesive team through the effective management of departmental resources
- Drive the implementation of talent acquisition, succession planning, development, and retention strategies for the department.
- Ensure the enhancement of relevant knowledge and skills through continuous coaching, mentoring and nurturing of departmental talent.
- Create a high performance culture and manage team performance effectively by translating and communicating the annual performance goals and measures into individual work plans based on agreed upon objectives.

EXPERIENCE
- 5 Years Medical Insurance environment
- 3 years Clinical Risk

QUALIFICATION
- B-Degree in Nursing

KNOWLEDGE
- Relevant legislation and regulatory frameworks
- Clinical Risk management
- Medical Knowledge
- Business Acumen
- Technical problem-solving
- Financial budgeting and management processes
- Project Management

SKILLS
- Verbal and Written Communication
- Conflict Resolutions
- Presentations
- Project Management
- Coaching and Mentoring

ATTRIBUTES
- Resilience
- Detail Orientation
- Innovative Thinking
- Customer Centric
- Strategic Thinking
- Results Focused
- Quality Focused
- Assertiveness
- Developing and Directing Others
- Teamwork
- Problem Solving
- Judgement and Decision Making
- Analytical Thinking
- Flexibility