The Regional Health Services and Network Procurement Manager is responsible for the design, implementation and management of the business and for acting as the expert in health service delivery and costs management in their region. Responsible for developing and delivering on a Network Strategy for their region and for identifying, contracting and managing a range of directly contracted medical providers, TPAs and third-party network providers in order to provide members with “easy” access to quality, value for money, directly steeled medical services and for managing the Cost of Claim in their region.
- The design, configuration and management of business, acting as Regional Network Owner, ensuring value for money, operational efficiency and high levels of customer satisfaction within region.
- The oversight of all service components that directly impact the network and the customer’s use of the network in Region such as, Provider Contracts, Provider Collateral, Provider Finder, Provider Portal, and Network Access Cards.
- Undertaking regular reviews of the network and health services provision in region including but not limited to: Network Utilisation, Regional Claims Trends and Patterns, Cost and Cost of Calms, Network accessibility and availability and maintaining such reports as may be reasonably required.
- Negotiating agreements with providers, networks, service suppliers (internal and external) and third-party administrators (TPA) in region, and for the ongoing management and development of said agreements and relationships to minimise the cost of claims while maximises access to quality medical and associated services and encourage providers, networks and service providers to act as advocates for the Company.
- Leading the development, implementation and maintenance of new regional health services and network features in region. For example, development of an “excellence” network in Region of Country Specific centres of excellence or developing a network solution for a specific Regional client group or country specific Network offering.
- Manage and deliver Health Services and Network related projects in region to time and budget. Where regional third parties are responsible for delivering such projects, take responsibility for managing said third parties such as Regional TPA’s or Providers and for on boarding new TPA and other providers in region.
- Be accountable for the total cost of claims in Region. The incumbent shall be responsible for managing the overall cost of claims, and for designing and implementing network and healthcare solutions designed to minimise the cost of calms in Region.
- Sales Support and Business Development
- Account Management
- Accountable for customer experience
- Strong written and oral communication skills, explaining complex issues clearly and concisely, presenting compelling arguments / proposals using fact based evidence and research, adapting style for maximum impact with audiences.
- Highly analytical and commercial with good planning, strategy and consultancy skills.
- Practised in developing and delivering on business cases, strategies and for managing budgets and delivering to targets and objectives.
- Practised negotiator practiced in negotiating complex commercial contracts for the provision of health services by providers and TPA’s with a view to achieving a balanced solution to the benefit of all.
- Strong team player, focussed on delivering own objectives while enabling / supporting others to deliver theirs.
- Self-motivated with ability to work effectively in a team in order to identify and overcome areas of delay that could impede resolving issues within set deadlines and acceptable service guidelines. Demonstrate initiative, flexibility and ability to drive and embrace change while motivating and leading teams through times change and of stressed resources.
- Ability to manage projects/client network implementations with multiple deadlines in a fast-paced, start-up operation while maintain a focus on delivery of results through personal effectiveness, problem solving & decision making and coordination of resources
- Ability to work autonomously as Regional managers may well be located “on their own” in Region and must be comfortable operating on their own being self-guided and self-managing.
- Ability to travel, the role will require the job holder to travel internationally and within their area of responsibility and is likely to spend a week a month or more traveling to meet with and work with, Providers and Partners. From time to time when working to establish new services etc. or when undertaking market contracting activities the incumbent may be required to be in country for 2 weeks or more at a time.
- Highly accountable able to addresses difficult or controversial issues. Accepts ownership of decisions, actions and problems. Demonstrates effective problem-solving skills.
- Innovative, able to invent new paradigms and takes an innovative approach to problem solving. Able to use existing resources in creative ways to improve results and able to apply learning from previous employee / market to develop and deliver market leading solutions to clients in a cost effective and operationally efficient manner. Where appropriate, demonstrating originality and thinking outside the box.
- Able to demonstrate a sound knowledge and understanding of the Healthcare/Health Insurance Industry, with a good understanding of healthcare economics and clinician provisioning as it relates to Healthcare purchasing and Medical claims management
- Educated to degree standard or equivalent practical experience.
- Multi-lingual skills highly desirable
- Experience of contract management and running structured tendering process, including ongoing development of standard terms and other apprise contracting.
- Strong negotiation skills, with emphasis in achieving results and successful outcomes.
- Experience of operating in an International, matrix management environment and of working as part of a dispersed team operating across time zones and cultures.
- Practised in working with third party providers and multiple internal organisations to deliver customer value and business efficiency, in particular practised in managing inter Group relationships where success is depended of effecting strong working relationships with “Group” companies.