Team Leader: Clinical Quality Assurance

Location: Centurion, Gauteng

Position Purpose: The Team Leader: Clinical Quality Assurance is responsible for leading and overseeing quality assurance audits and related activities to ensure high standards of care, regulatory compliance, and risk mitigation. The role focuses on transforming audit findings into actionable insights that drive quality improvement, reduce risk, and support sound governance.

• Clinical qualification with relevant experience in clinical auditing, quality assurance, or utilisation management.
• Proven experience in a healthcare, managed care, funder, or clinical governance environment.
• Solid understanding of South African healthcare regulatory frameworks (CMS, PMBs, risk adjustment).

• Matric
• Diploma/degree in nursing or related healthcare qualification.
• Qualification in Quality Management will be advantageous.

• Lead, mentor, and support a team of clinical and non-clinical auditors and quality reviewers to ensure consistent, high-quality outputs.
• Allocate work, monitor progress, and ensure adherence to audit schedules and delivery timelines.
• Plan, conduct, and oversee clinical audits in line with approved methodologies, regulatory requirements, and organisational standards.
• Ensure timely completion of clinical audits with clear, evidence-based and actionable recommendations.
• Conduct consistent quality assessments within agreed deadlines, providing meaningful feedback on identified quality issues, risks, and successes.
• Analyse clinical data to identify trends, patterns, risks, and improvement opportunities relating to appropriateness of care, readmissions, PMB compliance, and utilisation patterns.
• Compile high-quality clinical audit reports, dashboards, and presentations tailored to diverse stakeholders.
• Present audit findings, root-cause analyses, and improvement recommendations to clinical, operational, and governance forums.
• Engage proactively with teams, management, and other stakeholders to influence corrective action and quality improvement initiatives.
• Identify training and development gaps arising from audit outcomes and quality assessments.
• Track quality improvement initiatives to ensure measurable and sustained improvements over time.

• Strong clinical auditing and analytical skills with the ability to interpret complex clinical data.
• High attention to detail and ability to identify patterns, anomalies, and risks in clinical information.
• Proficiency in MS Office, particularly advanced Excel, and relevant clinical information systems.
• Excellent report writing, presentation, and stakeholder engagement skills.
• Strong problem-solving and decision-making capabilities.
• Ability to work independently while effectively leading and collaborating within a multidisciplinary team.
• Results-driven mindset with a focus on continuous quality improvement and risk reduction.

• Understanding of call centre technology
• Knowledge of scheme rules and contractual negotiations
• Knowledge and application of relevant legislation
• Knowledge and application of clinical processes and procedures

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.