Ditshaba Management Holdings Jobs

To apply, click on the link at the end of the posts and all the best with your applications.

Consultant – Medical Management

Job Category: Management

Job Type: 3 Years Contract

Location: Gauteng

Salary: R501 775 per annum

Reference ID: 5269
Start Date: 23 June 2025
Closing Date: 27 July 2025
Contract Type: 3-Year Fixed-Term Contract
Location: Gauteng

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Purpose of the Role

Our client is seeking a skilled Consultant: Medical Management to support the implementation of medical claims processes, manage medical exceptions, and provide administrative support in processing medical-related claims.

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Key Responsibilities

Medical Management

• Conduct medical assessments and compile injury assessment reports.
• Review submitted claims for level of care, length of stay, and quality of treatment.
• Apply relevant tariffs, treatment protocols, and cost-containment practices.
• Pre-authorise claims based on clinical guidelines and prescribed tariffs.
• Escalate complex cases for multi-disciplinary review.
• Participate in consultations related to the implementation of medical claims processes.

Exception Handling

• Implement and maintain formal exception-handling procedures.
• Document and regularly update all exception-handling processes.
• Address unusual case occurrences efficiently.

Reporting

• Track and report performance against targets.
• Identify and report emerging risks.
• Support process improvements through ad hoc reports and presentations.

Stakeholder Management

• Maintain professional communication with internal and external stakeholders.
• Resolve queries timeously, providing regular feedback and follow-up.
• Ensure stakeholder expectations are managed within agreed timelines.

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Minimum Requirements

Qualifications

• Bachelor’s Degree or Advanced Diploma in Health Sciences or a Medical-related field.
• Registration with HPCSA or SANCA (as applicable).

Experience

• Minimum of 3 years’ experience in a medical or healthcare environment, preferably within claims or case management.

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Competencies

• Claims processing and medical case management
• Medical billing and review
• Clinical analysis and problem-solving
• Stakeholder engagement and client service orientation
• Knowledge of healthcare regulations and claim-related legislation
• High level of ethics, judgment, and decision-making
• Strong planning and coordination abilities

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Additional Information

• This is a fixed-term contract position.
• Only shortlisted candidates will be contacted within six weeks of the closing date.
• Applicants with foreign qualifications must submit SAQA evaluation.

For more info , please call Refiloe 083 652 8035

Senior Officer: Project Delivery Management

Job Category: Management

Job Type: Permanent

Location: Gauteng

Salary: Competative Salary with Benefits

Closing date 27 June 2025

Location : Gauteng

Job Summary

Our client is seeking a highly motivated Senior Officer: Project Delivery Management to provide both technical and administrative support within the Programme Delivery Management department. The successful candidate will coordinate project activities, maintain project documentation, monitor schedules, and ensure projects are delivered on time and within budget.

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Key Responsibilities

• Coordinate and support project activities in line with defined standards and guidelines.
• Participate in risk assessments and proactively address project challenges.
• Manage scheduling and planning of project tasks, ensuring deadlines are met.
• Maintain accurate records and update project documentation consistently.
• Track project budgets, expenses, and procurement processes.
• Compile regular and ad-hoc reports for management and stakeholders.
• Liaise with internal and external stakeholders to ensure smooth project execution.
• Maintain positive relationships with vendors, service providers, and team members.

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Requirements

• Bachelor’s Degree or Advanced Diploma in Project Management or related qualification.
• Certification in project management methodologies (Prince2, PMBOK, Agile) is advantageous.
• Minimum 4 years’ experience in project coordination and management.
• Proficient in project management software and advanced Excel skills.
• Experience with SAP is a plus.
• Strong organizational, administrative, and communication skills.
• Ability to manage multiple tasks and projects simultaneously.

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Additional Information

• Applicants who have not been contacted within six weeks of the closing date should consider their applications unsuccessful.
• Security vetting may be conducted as part of the recruitment process.
• Foreign qualifications must be evaluated by SAQA with proof of evaluation submitted.

For more info please call Refiloe 083 652 8035

Consultant : Medical Management

Closing on: Jun 30, 2025

Job Category: Management

Job Type: 12 Months Contract

Location: Pretoria

Salary: R501 775 per annum

Purpose of the job: The Consultant: Medical Management is responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing. 

Key Performance Areas

Medical Management

• Conduct medical assessment and compile injury assessment reports.
• Conduct assessments and bill reviews on submitted claims, focusing on the appropriate level of care, the length of stay, and quality of care.
• Incorporate tariffs, cost savings initiative recording, and treatment protocol to ensure that all service providers adhere to the rules, and the tariff as guided by the company and / or any that is considered reasonable.
• Pre authorise submitted claims aligned to the company’s clinical guidelines including the company formularory, treatment protocols and related tarrifs.
• Escalation of complex cases for multi disciplinary review and adjudication.
• Participate in the consultations process on the implementation of medical claims processes.

Exception Handling

• Ensure the implementation and maintenance of a formal exception handling process within the medical management.
• Maintain the documentation and regular updating of the exception handling process.
• Maintain the implementation an unusual occurrence procedures.

Reporting

• Track and report against set objectives and targets.
• Report on emerging risks.
• Provide ad hoc reports on process improvement initiatives.
• Produce documents, briefing papers, reports and presentations.

Stakeholder Management

• Deal with/and respond to correspondence.
• Maintain healthy relationships with all stakeholders.
• Follow up and resolve all queries, following up and making recommendations on which corrective actions are appropriate.
• Follow up and feedback to all stakeholders to keep them updated on the status of a query.
• Respond to queries within the predefined turnaround times.

Qualifications

• Bachelor’s Degree/Advanced Diploma in Health Sciences /Medical related qualification.
• Registration with HPCSA/SANCA.

Experience

• Relevant 3 years’ experience in a Medical related environment.

Technical and behavioral competencies required

• Claims management process/ processes and systems.
• Medical product management
• Medical bill reviewing
• Medical case management
• Complex problem identification, solving and decision making
• Customer value proposition
• Strong clinical analytical capabilities
• Knowledge of motor vehicle accident legislation
• Planning, Organising and Coordinating
• Personal Mastery
• Judgement and Decision Making
• Ethics and Values
• Client Service Orientation

For Job Related Queries contact Nsuku at 0837390512.

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We wish you all the best with your applications