Funder Relations Manager

Job Title

The Funder Relations Manager

Responsibilities

• Head up funder engagements including contracting, annual negotiations, and oversee business relationships between Netcare Medical schemes, medical scheme administrators, and health insurers for the Group.
• Assist in developing company strategy for tariff negotiations, act as a team member at tariff committee meetings, and conduct negotiations with schemes and insurers.
• Manage new client evaluation, support registration, and tariff master inputs.
• Understand medical scheme pressures and design responses, ensure familiarity with ICD and CPT coding.
• Harness strong relationships with medical schemes, administrators, and managed healthcare companies.
• Work with the team in developing strategies for contracting, tariff negotiations, restricted hospital networks, and value-based contracting.
• Present proposals and recommendations to the Tariff Committee, conduct negotiations, draft terms sheets, and oversee tariff master inputs.
• Perform financial and statistical analysis on funders, costs, and changes in cost of services, review cost efficiency per event.
• Establish formularies for ethical and surgical procedures, provide direction on overall hospital cost drivers.
• Ensure sound relationship management with funders, coordinate meetings with internal departments, and engage with diverse teams.

Qualifications

• Relevant Degree or a Diploma at an NQF Level 7 in Commerce, Legal, or healthcare-related field.
• Minimum of 10 years of medical scheme or scheme administrator experience in operational and management roles.

Knowledge and Skills

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

About the Role

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