Funder Relations Manager

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We are united by a common purpose of providing the best and safest care; and by our shared values of Care, Truth, Participation, Compassion and Dignity.

Netcare invites you to be part of our journey.

The Funder Relations Manager is responsible for heading up the funder engagements including contracting, annual negotiations and oversees the business relationship between Netcare Medical schemes, medical scheme administrators and Health Insurers for the Group.

Tariff Negotiations

• Assist in the development of the company strategy for tariff negotiations.
• Act as a team member at tariff committee meetings.
• Conduct tariff negotiations on an annual and ongoing basis with schemes and medical insurers as allocated.
• Manage new client evaluation and supporting of registration and tariff master inputs.
• Understand medical scheme pressures and design a response and approach to addressing these.
• Ensure familiarity with ICD and CPT coding.

Adverse Events and Complaints Management

• Harness strong relationships with medical schemes, administrators, and managed healthcare companies.
• Understand medical scheme macro environment and design relevant response and approach to addressing these.
• Work with the team in the development of the company strategy for contracting and tariff negotiations across various areas including the hospital division, mental health, cancer care and medical diagnostics.
• Work with the team in developing strategies on restricted hospital networks; procedure-based networks and value-based contracting.
• Present proposals and recommendations to the Tariff Committee.
• Conduct tariff negotiations on an annual and ongoing basis with medical schemes, administrators and medical insurers as allocated.
• Drafting terms sheets and Contract reviews.
• Overseeing the loading of annual tariff master inputs.

Analysis and Reporting

• Financial and statistical analysis on funders, costs, and changes in cost of services.
• Apply a hands-on approach to sourcing, review, and analysis of data.
• Review the cost efficiency per event as published and shared by funders.

Project Management

• Establish formularies for ethical and surgical (this is in the control of pharmacy, however the interface and interaction on this needs to be coordinated in discussions with Funders who have their own requirements).
• Provide direction on overall hospital cost drivers.

Stakeholder relationships

• Ensure sound relationship management with Funders and administrators specifically key account management.
• Coordinate meetings with funders and internal Netcare departments including Case Management, Billings, Shared Services and Credit Management in particular.
• Define and agree on the processes and take leadership in finalizing Netcare’s position at meetings whilst being advised by the divisional experts.
• Engage with diverse teams and individuals specifically managing the contributions and inputs from individuals not under direct management control and at times senior in position.

EDUCATION

• Relevant Degree or a Diploma at an NQF Level 7 in Commerce, Legal or healthcare related.

WORK EXPERIENCE

• A minimum of 10 years medical scheme or scheme administrator experience operational and management experience.

KNOWLEDGE

• Strong commercial nous, Negotiation, and contract experience. In-depth knowledge of hospital billing methods advantageous,
• Strong knowledge of ICD and CPT coding.
• Ability to work and communicate with various stakeholders at different levels.
• In-depth knowledge of hospital billing methods and medical scheme principals.
• Hospital operational experience.

Join the team committed to providing the best and safest health and care.