Manager - Healthcare Provider Networks

Location: Centurion, Gauteng

Position Purpose:We are seeking an experienced and driven Manager: Healthcare Provider Network to support the development, optimisation, and performance of our national provider network.

In this pivotal role, you will ensure that our members have access to high quality, cost effective care by strengthening provider partnerships, enhancing network performance, and overseeing the operational execution of network strategy. You will work closely with hospitals, specialists, GPs, allied providers, and pharmacies to deliver a sustainable, compliant, and efficient healthcare ecosystem.

Experience & Qualifications:

Degree or Diploma in Health Sciences, postgrad in Business, or related field will be advantageous

• 5-7 years in healthcare provider networks, managed care, or medical scheme operations.
• Strong experience engaging with hospital groups, specialists, and primary care providers.
• Experience interpreting clinical/claims data and network performance indicators.
• Leadership or supervisory experience (advantageous).

Network Development & Management:

• Implement and manage the healthcare provider network strategy across all provider disciplines.
• Oversee provider onboarding, updates, network adequacy assessments, and operational stability.
• Support the rollout of DSP arrangements, Centres of Excellence, and alternative reimbursement models.

Provider Relationship & Engagement:

• Monitor DSP compliance, leakage, quality metrics, and utilisation patterns.
• Prepare performance insights and network reports to support decision making.
• Recommend and implement interventions for underperforming providers or high risk trends.

Contracting & Compliance Support:

• Support contracting activities, documentation, and digital contracting workflows.
• Ensure provider adherence to contractual obligations, benefit rules, and clinical protocols.
• Uphold CMS, PMB, POPIA, audit, and internal governance standards.

Digital Enablement:

• Promote adoption of e-authorisation, digital contracting, provider portals, and clinical information systems.
• Provide support to providers experiencing system challenges and collaborate with IT for resolution.
• Lead and develop the provider network team, ensuring high performance and professional conduct.
• Coach staff, manage performance, and drive continuous improvement.
• Strong relationship and stakeholder management skills.
• Excellent communication and conflict resolution abilities.
• Analytical and data interpretation skills.
• Solid understanding of provider contracting, PMBs, clinical coding, and managed care principles.
• High attention to detail and governance discipline.
• Digital literacy (provider portals, BI tools, workflow systems).

Note: Company reserves the right to close the advert before specified closing date.

PHA has its head office in Westville, KwaZulu Natal. It operates country wide with a nationally linked network and uses a robust, flexible, as well as integrated system to ensure efficient and effective administration of membership and benefits.