Health Product Manager

Kaelo - Johannesburg, Gauteng 2196

Company Description


About Kaelo

Kaelo provides essential healthcare solutions ensuring the physical and psychosocial wellbeing of all South Africans towards lasting social change.


Job Description


Network Management -

  • The Product Manager supports the business by ensuring that members have access to primary healthcare benefits via a multidisciplinary network of healthcare providers at an affordable and sustainable rate
  • Oversight of the following items which are implemented by the Networks team:
  • All providers contracted to Prime Cure must have signed a valid contract and completed the information sheet and provided Prime Cure with all required documentation, for example BHF registration, HPCSA certificate
  • Annual Fee negotiations with various providers including the Hospital networks, pharmacy groups, Laboratories and other disciplines.
  • Driving the strategic objective of the company by ensuring network growth and stability, a happy educated provider who is a partner in the delivery of rational appropriate and cost effective healthcare
  • The ownership and management of the primary care benefit stack, ensuring that the benefits marketed and sold can be delivered efficiently via the administration system and network of providers
  • Ensure Managed Care Accreditation

Risk Management

  • The Product Manager supports and manages the design, implementation and evaluation of member management and GP utilisation programmes thereby ensuring that members receive and providers provide rational appropriate cost effective healthcare. The main objective of these programmes is too ensure that members lead a healthy, happy and productive life

Kaelo Health Product owner

  • The Product Manager ensures that the numerous Kaelo Health option benefits including that of Schemes, white label products and other Insurer products related documentation and delivery is as per the rules and policy documents.

KEY OUTCOMES (not limited to) Level 4 and 5 process elements

Stable national network of providers ensuring that the member base has access to a contracted provider

Negotiations of fees with all providers – contracted and non-contracted

Co-ordination and management of provider profiling, peer review and intervention with outliers

Risk Analysis as a member of the risk forum

  • Demographics
  • Geographic’s
  • Individuals to groups
  • Utilisation
  • Identification of high risk high claiming members
  • Disease Burden
  • Employer profile

Design of capitation products together with sales and marketing and MANCO for:

  • Primary services
  • Secondary services
  • Tertiary Services

Client executive of Prime Cure clients including schemes

  • Negotiation of contracts and fees
  • Design of products and benefits
  • Analysis of risk factors and potential solutions

Analyses and reporting of:

  • Utilisation
  • Claims to capitation fee ratio
  • Effect of managed care interventions
  • Underwriting

Product and Benefit Design9New and Enhancements

  • Presentations to Board of Trustees for the schemes
  • Scheme Road shows –Product pack for operational delivery to new and existing members
  • Ensuring that the Service Level Agreements with clients are met and client expectations are managed
  • Ensure retention of existing clients
  • Identification and management of high risk claiming members and providers ensuring rational, appropriate cost effective health

The Product Manager – ensuring that that the numerous health option benefits, related documentation, branding and MIP system setup is as per the health rules and policy documents


Qualifications


SPECIAL REQUIREMENTS

Communication skills, Industry experience and knowledge

PERSON DETAILS: WORK EXPERIENCE

REQUIRED

At least 5 years’ experience in the healthcare Industry/ Insurance at a senior level

3 years project management/paralegal experience

PREFERRED

EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY

REQUIRED

Project Management

Business management

PREFERRED

Health Regulatory or Paralegal

TECHNICAL SKILLS OR KNOWLEDGE

REQUIRED

Decision Making Skills

Organisational Skills

Communication Skills

Negotiation Skills

Strategic Planning Skills

Ability to work well within a team

Leadership Skills

Ability to work under stress and tight deadlines

Knowledge of the Healthcare Industry

PREFERRED

Knowledge of the Healthcare Industry


Additional Information


PERSONAL ATTRIBUTES : COMPETENCIES

  • Accountability
  • Communication
  • Business writing skills
  • Efficient and effective mindset
  • Planning and organisation
  • Resilient and adaptive
  • Self-development
  • Significance and values oriented
  • Ethical
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