Risk Manager: Managed Care Specialty Contracting

The Focus Group Sandton, South Africa 05 June 2026 Mid / Senior 1000000 \- 1500000 Full Time Cost to Company 5 years \- 8 years Skills Healthcare Medical Pharmaceutical Industries Healthcare Medical Pharmaceutical Job Description CLIENT A top medical aid administrator with a strong managed care program for Optometry and Renal Dialysis (amongst other disease areas) is seeking candidates who either have strong OPTOMETRY or RENAL DIALYSIS subject matter expertise (two positions) coupled with strong benefits design optimization, risk management, contracting management, and regulatory compliance experience as well as strong industry stakeholder relationships. Key Purpose To manage strategic risk priorities with contracted specialty groups focusing on optometry and renal providers: To manage and oversee all aspects of optometry benefits, risk, and industry engagement across all schemes and plan options within Discovery Health and serve as the strategic and operational Subject Matter Expert (SME) on optometry, ensuring benefit design optimization, regulatory compliance, and sustainable utilization while maintaining strong industry relationships; AND/OR To manage, optimize, and oversee the full renal dialysis benefit, provider networks, risk exposure, and value\-based care strategy across all schemes and plan types within CLIENT. And be responsible for designing and implementing sustainable dialysis care models, contracting frameworks, and operational processes that ensure optimal clinical outcomes, cost efficiency, and compliance with scheme rules and national health policy. KEY REQUIREMENTS **Qualifications:** Bachelor’s degree or equivalent in health sciences, optometry/Renal dialysis, business, or a related field. Postgraduate studies or certifications in healthcare management, risk management, or optometry or Renal Dialysis (advantageous). **Experience:** Minimum 5\-7 years in healthcare benefit design, network management, or managed care roles, with significant exposure to optometry / Renal Proven track record in relationship management with external healthcare providers and industry stakeholders within optometry / Renal **Technical Competencies:** Deep understanding of optical benefit structures, coding systems, and reimbursement models. Knowledge of PMB processes and Ex Gratia protocols. Strong analytical skills for benefit optimisation, utilisation management, and financial impact assessments. Familiarity with claims processing, provider billing rules and system configuration requirements. **Behavioral Competencies:** Strategic thinking and problem\-solving ability. Strong interpersonal and communication skills to build trust with industry partners and internal teams. High attention to detail with commitment to accuracy and compliance. Leadership capability to drive cross\-functional projects and influence scheme\-wide decisions beyond the scope of the direct portfolio. KEY RESPONSIBILITIES \- OPTOMETRY **Key Account and Relationship...