Titre du poste

Service Manager - Managed Healthcare - Gaborone, Botswana

Description

Position : Service Manager - Managed Healthcare - Gaborone, Botswana

We are looking for a Service Manager - Managed Healthcare.
The role is responsible for overseeing and managing the delivery of managed healthcare services within the organisation, including utilisation management and risk management. The role ensures that clinical decisions, and benefit administration are aligned with client rules, clinical guidelines, and cost-containment strategies while maintaining quality care for members. The incumbent will also provide leadership and strategic direction to the managed healthcare team to ensure efficient service delivery, regulatory compliance, and optimal member outcomes.
Operations & Service Delivery

  • Oversee complex and high-risk medical cases to ensure appropriate treatment pathways and optimal patient outcomes.
  • Ensure effective clinical case management processes for members requiring ongoing or specialised care.
  • Coordinate with healthcare providers to facilitate appropriate care plans and discharge planning where applicable.
  • Monitor adherence to clinical guidelines and protocols in case management activities.

Benefit Utilisation Management

  • Oversee pre-authorisation for hospital admissions, specialised radiology, procedures, chronic conditions and high cost interventions.
  • Ensure clinical decisions align with Scheme rules, treatment guidelines, and evidence based medicine.
  • Monitor turnaround times for pre-authorisation and ensure adherence to agreed Service Level Agreements (SLAs).
  • Ensure proper documentation, record keeping and confidentiality of member information.

Clinical Risk Management

  • Implement strategies to manage healthcare utilisation, reduce wastage, and promote cost-effective care.
  • Review high cost cases through effective case management for on-going inpatient monitoring.
  • Identify trends, emerging risks, or inappropriate utilisation and propose interventions.
  • Support development and review of clinical protocols, benefit guidelines and managed care policies.
  • Work with healthcare providers to ensure appropriate treatment pathways and adherence to agreed clinical and funding protocols.

Stakeholder Engagement

  • Build and maintain relationships with healthcare providers, specialists, hospitals, and third-party partners.
  • Engage with internal stakeholders such as Claims, Membership, Finance, Provider Networks and Client Services to ensure seamless workflows.
  • Represent the department in cross-functional operational meetings and Scheme engagements.

Leadership & Team Management

  • Provide strategic direction and leadership to the team.
  • Set performance targets, monitor outputs and ensure continuous performance improvement.
  • Coach, mentor, and develop staff to enhance clinical and operational efficiency.
  • Manage workforce planning, leave schedules, training needs and performance reviews.
  • Promote a culture of collaboration, accountability, and continuous improvement.

Reporting and Compliance

  • Compile monthly, quarterly, and ad-hoc reports on utilisation trends, turnaround times, escalations and cost drivers.
  • Ensure departmental compliance with legislative, regulatory and Scheme requirements.
  • Develop and maintain Standard Operating Procedures (SOPs) for all departmental processes.
  • Monitor audit findings and implement corrective and preventative actions.

Required profile for job ad : Service Manager - Managed Healthcare - Gaborone, Botswana

Job Requirements:

  • A relevant Clinical Qualification (Degree or higher)
  • Registration with the relevant professional body
  • 8 years experience in Managed Healthcare, Hospital Benefit Management, Case Management or Clinical Practice.
  • Minimum 3-5 years in a middle-senior management role
  • Experience in medical aid/healthcare funding environment
  • Knowledge of managed care principles, ICD-10 coding and medical aid benefit structures.

Job Related Knowledge and Skills:

  • Strong clinical judgement and understanding healthcare protocols.
  • Excellent people management and coaching skills.
  • Analytical and problem-solving abilities.
  • Strong communication and stakeholder management skills.
  • Ability to work in fast-paced, high-pressure environments.
  • High attention to detail and commitment to accuracy.
  • Familiarity with medical systems, workflows, and utilisation management tools

Job criteria for job ad : Service Manager - Managed Healthcare - Gaborone, Botswana

  • Job category :
    Health and social professions
  • Industries :
    Health, pharmacy, hospitals, medical equipment - Pharmaceutical industry
  • Employment type : Fixed-term contract
  • Region : Gaborone
  • City : Gaborone, Botswana
  • Remote work :
    No
  • Experience level : More than 10 years
  • Educational level : Bachelor - Master
  • Spoken language :
    english > fluent
  • Number of Position(s) : 1
  • Team management :
    Yes
  • Empathic
  • Results driven
  • Customer Satisfaction
  • Strong Leadership
  • Excellent communication skills
  • Reporting & Analysis
  • Radiology
  • Medicine
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Type de poste
Temps plein
Lieu du poste
Gaborone, Botswana, Botswana
Date de publication
9 avril 2026
Valide jusqu’au
7 juin 2026
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Poste : Service Manager - Managed Healthcare - Gaborone, Botswana

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