Chief Medical Officer- Medical schemes

This executive role is pivotal in driving the Clinical Risk strategy, ensuring financial sustainability, operational excellence, and compliance with healthcare and governance frameworks.

 

Key Purpose

Lead the design, implementation, and monitoring of Client’s Clinical Risk and Managed Care strategies to promote clinical excellence, strengthen governance, and ensure long-term scheme sustainability. The CMO will provide expert oversight of healthcare delivery models, contract management, and stakeholder partnerships that advance Client’s mission of member well-being.

 

Key Responsibilities

• Strategic Leadership: Develop, execute, and monitor the Clinical Risk strategy aligned to Client’s overall strategic objectives.
• Contract & Partnership Management: Oversee negotiation, contracting, and performance monitoring of healthcare providers, managed care organisations, and service partners to ensure value for money and quality outcomes.
• Risk & Compliance Oversight: Ensure robust governance, adherence to statutory and regulatory requirements, and implementation of effective risk mitigation strategies.
• Financial Stewardship: Lead budget planning, healthcare cost containment, and financial optimisation within the Clinical Risk Division.
• Operational Excellence: Drive continuous improvement through data-driven decision-making, process optimisation, and innovation in care management.
• Stakeholder Engagement: Build and maintain strong relationships with internal and external stakeholders, including healthcare providers, regulators, and industry bodies.
• People Leadership: Inspire and lead a high-performing multidisciplinary team, fostering a culture of accountability, collaboration, and performance excellence.

 

Qualifications & Experience

• Medical Degree (MBChB) and registration with the HPCSA.
• Minimum 10 years’ experience at Senior Managerial Level in Clinical Risk or Managed Care.
• At least 5 years at Executive Level within a healthcare or medical scheme environment.
• Proven experience in contract negotiation, strategic management, and financial governance.
• Advanced knowledge of healthcare legislation, clinical risk management, and strategic leadership principles.