Care Coordinator Manager

The Care Coordination Manager is responsible for leading, managing, and optimising the Care Coordination Department to ensure the effective delivery of high quality, patient centred clinical coordination services. The role provides clinical oversight, ensures adherence to managed care principles, proactively identifies and mitigates clinical risks, and drives the implementation of strategies that enhance clinical outcomes, operational efficiency, and client satisfaction.

Degree in Health Sciences; postgraduate qualification advantageous.

• Minimum 5 years' experience in managed care, clinical risk management, or health-related customer service within the medical scheme administration industry or a comparable healthcare setting, with at least 2 years in leadership.
• Strong knowledge of the SA healthcare market, PMBs, and managed care principles.
• Experience in data analytics and performance management.

• Lead the Care Coordination Department to ensure efficient delivery of care coordination services.
• Translate the managed care and care coordination strategy into operational activities.
• Monitor departmental performance and implement continuous improvement initiatives.
• Ensure clinical governance standards are upheld across care coordination activities.
• Proactively identify clinical risks related to patient care or contracted services.
• Coordinate appropriate interventions or escalate issues to subject matter experts.
• Provide specialist clinical input into decision making and case reviews.
• Ensure adherence to evidence based guidelines, policies, and scheme rules.
• Support the development of cost effective care processes that optimise health outcomes while preventing unnecessary utilisation.
• Continuously assess the cost benefit and ROI of care coordination initiatives.
• Strengthen demand management practices within the department.
• Maintain and share specialist clinical knowledge across teams.
• Provide training, coaching, and mentorship to clinical staff.
• Ensure staff remain compliant with professional development and CPD requirements.
• Foster a culture of continuous learning within the department.
• Collaborate with internal teams to ensure seamless delivery of care coordination services.
• Build positive relationships with medical schemes, service providers, and other stakeholders.
• Present managed care and care coordination reports to clients effectively.
• Ensure client needs are understood and integrated into operational planning.
• Provide specialist input into organisational and client-specific projects.
• Apply sound project management principles when contributing to project teams.
• Represent Care Coordination at committees and governance structures.
• Analytical and numerical reasoning
• Clinical assessment and critical thinking
• Advanced computer literacy (healthcare systems, reporting tools)
• Problem solving and decision making

• Integrity and credibility
• Ownership and accountability
• Collaborative leadership style
• Innovative and improvement driven
• Ability to influence and engage diverse teams
• Detail oriented with strong follow through

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.