Specialist – Hospital Network and Relations

Position:
Specialist – Hospital Network and Relations

Location: Centurion, Gauteng

We are looking for an analytical, detail‑oriented, and relationship‑driven Specialist:
Hospital Network to support the management and optimisation of our hospital provider network. In this role, you will work closely with private hospital groups and independent hospitals to ensure high‑quality, cost‑effective care for members. You will play a key role in hospital performance analytics, contracting support, provider relationship management, and digital enablement — helping us deliver improved clinical outcomes and sustainable healthcare costs.

If you thrive in a fast‑paced environment, enjoy working with data, and excel at building trusted provider relationships, this is the opportunity for you.

Degree or Diploma in Health Sciences, postgrad in Healthcare Management, Business Management, or related field will be advantageous

• 3–5 years’ experience in hospital networks, managed care, healthcare provider management, or medical schemes.
• Knowledge of hospital operations, DRG models, ICD‑10/CPT coding, and reimbursement frameworks.
• Experience working with hospital groups, facility managers, or clinical/operational teams.
• Strong experience in data analysis and claims utilisation.

• Support the implementation and day-to-day management of the hospital network strategy.
• Coordinate hospital onboarding, updates, accreditation (where applicable), and network record maintenance.
• Ensure hospital information is accurate across internal systems and member‑facing platforms.

• Analyse hospital claims, utilisation trends, LOS variance, readmission rates, and high‑cost case patterns.
• Build dashboards, scorecards, and reports to support decision‑making and network optimisation.
• Identify risks or anomalies and propose corrective interventions.

• Prepare negotiation data packs, tariff analyses, and DRG or global‑fee performance insights.
• Manage contracting workflows, including documentation, e‑contracting processes, and version control.
• Communicate contract changes and ensure hospital understanding of obligations.

• Assist hospitals in adopting digital tools such as e‑authorisation systems, digital contracting, and provider portals.
• Troubleshoot system issues with IT/digital teams where required.
• Track and improve hospital digital utilisation.

• Act as a key operational contact for hospital management teams.
• Resolve hospital queries, disputes, and escalations quickly and professionally.
• Support hospital visits, performance review meetings, and provider education sessions.

• Ensure all documentation and interactions comply with CMS rules, PMB requirements, POPIA, and audit standards.
• Maintain accurate, audit‑ready records of contracts, performance reports, and provider engagements.
• Strong analytical and problem‑solving skills.
• Excellent communication and stakeholder management abilities.
• Ability to interpret financial, clinical, and utilisation data.
• High attention to detail and accuracy.
• Proficiency in Excel, BI tools, and digital healthcare systems.
• Ability to work independently and collaboratively with cross‑functional teams.

Note:
Company reserves the right to close the advert before specified closing date.

PHA has its head office in Westville, Kwa Zulu‑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.