Health Risk Manager – Managed Health Care (Mozambique)

About the role

The Health Risk Manager will lead a cost‑effective Managed Health Care programme in Mozambique, ensuring appropriate use of private healthcare facilities while controlling costs and delivering quality patient outcomes. The role involves coordinating post‑hospital care, educating members on benefits, and implementing clinical guidelines.

Key responsibilities

• Coordinate post‑hospital care in line with business practices and product rules.
• Educate members about health‑care benefits to improve understanding and satisfaction.
• Develop, implement and communicate clinical guidelines for cost‑effective care.
• Authorize medical care and treatment that align with product and business procedures.
• Implement and monitor programs that reduce high‑cost hospitalisations linked to chronic diseases.
• Ensure correct application of exclusions and adherence to policies, procedures, and legislative requirements.
• Resolve escalated queries promptly and maintain accurate incident documentation.
• Manage cost of inpatient and outpatient episodes by applying appropriate policies and guidelines.
• Identify and escalate financial and business risks.
• Communicate with providers to improve cost efficiencies and meet Service Level Agreements.

Required profile

• Medical Doctor qualification with professional registration.
• 3–5 years of clinical and case‑management experience.
• Knowledge of managed health‑care systems and healthcare delivery.
• Strong communication, analytical and problem‑solving abilities.
• Compassionate, organised and client‑focused approach.

Required skills