{"id":2047487,"url":"https://alion.io/job/discovery-contract-manager","title":"Contract Manager","company":{"id":1811548,"name":"Discovery","domain":"discovery.co.za","url":"https://alion.io/company/discovery-co-za","size_band":"501-1000","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"SuccessFactors","truth_index":null},"role":"Legal","role_family":"Legal","seniority":"senior","employment_type":"contractor","work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Sandton, South Africa"],"countries":["ZA"],"hiring_countries":[],"hiring_countries_total":0,"salary":null,"salary_estimate":{"min_usd":26000,"max_usd":64000,"period":"year","method":"role_seniority_country_remote_cell","sample_n":13},"experience_years_min":5,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[],"status":"live","first_seen_at":"2026-10-07T00:00:00Z","employer_posted_date":null,"last_verified_at":"2026-10-07T00:00:00Z","board_verified":false,"closed_at":null,"days_open":4,"trust":{"level":"not_scored","repost_count":null,"flags":[],"days_open":4},"description":"Discovery Health – SRM\n\nSpeciality Contracting Risk Manager \r\n\nAbout Discovery \n\nDiscovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating to not only achieve financial success, but to ignite positive and meaningful change within our society.\n\nKey Purpose\n\nTo manage strategic risk priorities with contracted speciality groups focusing on optometry and renal providers: \n\nTo 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 optimisation, regulatory compliance, and sustainable utilisation while maintaining strong industry relationships.\n\nTo manage, optimise, and oversee the full renal dialysis benefit, provider networks, risk exposure, and value-based care strategy across all schemes and plan types within Discovery Health. 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.\n\nAreas of responsibility include but may not be limited to:\n\nKey Responsibilities in Optometry:\n\nKey Account and Relationship Management:\n\nAct as the primary relationship manager between Discovery Health and external stakeholders in the optometry industry, including professional bodies, optical administrators, and individual optometrists.\n\nMaintain effective communication and partnership with industry representatives to ensure alignment with professional standards and practices.\n\nBenefit Design and Strategy:\n\nDesign, build, and steer optical benefits for new medical schemes joining Discovery Health and for new plan options for existing schemes.\n\nProvide strategic advice on benefit optimisation to ensure competitiveness, member value, and cost-effectiveness.\n\nSubject Matter Expertise (SME):\n\nServe as the internal SME for all business areas requiring optometry input.\n\nProvide technical input into Prescribe Minimum Benefit (PMB) processes, Ex Gratia requests, and member or provider escalations.\n\nPrice File Management and Coding Updates:\n\nEnsure price files are updated three times per month in line with industry updates and scheme requirements.\n\nOversee quarterly updates to industry coding and rules, ensuring accurate system configuration and operational readiness.\n\nContract Ownership and Risk Management:\n\nAct as contract owner for lower plan types, managing utilisation, benefit structures, and associated risks in collaboration with Industry Optical Administrators.\n\nMonitor, analyse, and mitigate risks to ensure sustainability and value delivery to schemes and members.\n\nCommittee Leadership:\n\nChair the Sasolmed Optical Benefit Review Committee for optical escalations, ensuring fair, evidence-based decisions aligned with scheme rules and industry standards.\n\nKey Responsibilities in Renal:\n\n1. Strategic Network Design and Management\n\nLead the design, development, and implementation of dialysis provider networks, including KeyCare DSP, VBC (Value-Based Care) networks, and DDN (Discovery Dialysis Network).\n\nOversee network adequacy, capacity planning, and geographical coverage to ensure equitable access for all members.\n\nDevelop and refine co-payment structures, direct-to-member payment rules, and in-hospital vs out-of-hospital funding strategies to drive appropriate utilisation and cost containment.\n\n2. Contracting and Value-Based Agreements\n\nDesign, negotiate, and implement dialysis provider contracts, including:\n\nFee-for-service agreements\n\nValue-based care models with outcome-linked reimbursements\n\nCapitated or bundled payment arrangements where appropriate\n\nDefine pricing structures ensuring sustainability and alignment with plan benefits and industry standards.\n\n3. Risk Management and Benefit Sustainability\n\nAnalyse dialysis utilisation trends, admission rates, and cost drivers to inform scheme risk management strategies.\n\nDevelop mitigation measures, such as network restrictions, benefit limits, and clinical entry criteria, to manage financial risk without compromising clinical care.\n\nImplement data-driven frameworks to monitor provider performance, patient outcomes, and cost effectiveness.\n\n4. Clinical and Operational Protocols\n\nCollaborate with clinical teams to define dialysis care pathways, treatment authorisation protocols, and quality indicators.\n\nOversee updates to dialysis-related price files, procedure codes, and benefit rules to ensure accuracy and operational readiness.\n\nProvide SME input into system configuration for benefit rules, claim edits, and authorisation workflows.\n\n5. Stakeholder and Relationship Management\n\nAct as the primary relationship manager for dialysis providers, industry stakeholders, and internal departments requiring renal expertise.\n\nLead engagements with external providers to align operational processes, data submission standards, and network compliance.\n\nFacilitate internal education on renal benefit structures and policy changes.\n\n6. Project Leadership and Future Care Models\n\nLead strategic projects to transition renal dialysis benefits to advanced managed care models incorporating:\n\nRisk-sharing arrangements\n\nIntegrated chronic disease management\n\nFuture readiness for National Health Insurance (NHI) alignment\n\nDrive proposals and implementation plans for new models, such as:\n\nCapitation or partial capitation models\n\nVirtual care integration for dialysis patients\n\nHolistic chronic kidney disease (CKD) management pathways, including pre-dialysis interventions\n\n7. Governance and Compliance\n\nEnsure dialysis network and benefit models comply with regulatory frameworks and scheme rules.\n\nLead periodic reviews of dialysis policies to align with updated clinical guidelines and scheme strategic objectives.\n\nKey Requirements:\n\nQualifications:\n\nBachelor’s degree or equivalent in health sciences, optometry, business, or a related field.\n\nPostgraduate studies or certifications in healthcare management, risk management, or optometry (advantageous).\n\nExperience:\n\nMinimum 5-7 years in healthcare benefit design, network management, or managed care roles, with significant exposure to optometry.\n\nProven track record in relationship management with external healthcare providers and industry stakeholders within optometry.\n\nTechnical Competencies:\n\nDeep understanding of optical benefit structures, coding systems, and reimbursement models.\n\nKnowledge of PMB processes and Ex Gratia protocols.\n\nStrong analytical skills for benefit optimisation, utilisation management, and financial impact assessments.\n\nFamiliarity with claims processing, provider billing rules and system configuration requirements.\n\nBehavioral Competencies:\n\nStrategic thinking and problem-solving ability.\n\nStrong interpersonal and communication skills to build trust with industry partners and internal teams.\n\nHigh attention to detail with commitment to accuracy and compliance.\n\nLeadership capability to drive cross-functional projects and influence scheme-wide decisions beyond the scope of the direct portfolio.\n\nEMPLOYMENT EQUITY \n\nThe Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. 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