Senior Manager: Clinical Governance & Benefit Design

Are you an experienced clinical leader with a strong understanding of medical scheme governance, evidence-based benefit design and clinical risk? POLMED is seeking a Senior Manager: Clinical Governance & Benefit Design to lead clinical governance, medical policy development, benefit design and ex-gratia management while supporting the Scheme’s financial sustainability and regulatory compliance.

Reporting to the Executive: Operations, this role will provide strategic clinical leadership and executive-level stakeholder engagement across the Administrator, MCOs and other strategic partners.

What you will be responsible for

Benefit Design & Policy Management (30%)

• Update clinical protocols and medical policies.
• Manage scheme rules and benefit schedule amendments.
• Govern ex-gratia processes and ensure appropriate oversight.
• Lead evidence-based benefit reviews to support member needs, quality and financial sustainability.

Clinical Governance & Risk Management (30%)

• Develop and implement the clinical risk strategy.
• Establish and oversee clinical audit frameworks.
• Monitor clinical governance and clinical risk management.
• Prepare accurate and timely Board and CMS reporting and support regulatory compliance.

Strategic Vendor & SAPS Executive Alignment (25%)

• Lead high-level stakeholder engagement across SAPS leadership, the Administrator, MCO executives and other strategic partners.
• Align healthcare delivery, vendor performance and clinical priorities with Scheme requirements.
• Drive effective executive-level relationships and escalation management.

People & Financial Management (15%)

• Provide leadership, coaching and team performance management.
• Build capability, accountability and a high-performance team environment.
• Manage the functional budget and financial resources within approved parameters.

What you'll bring

• MBChB degree is a requirement.
• Registration with the HPCSA is essential.
• Ideally 6–8 years’ medical scheme clinical management experience.
• Demonstrated knowledge of medical scheme clinical governance, benefit design and clinical management.

You'll thrive in this role if you have:

• Strong clinical governance, risk management and analytical capability.
• Evidence-based benefit design and medical policy development expertise.
• Sound understanding of the Medical Schemes Act, Scheme Rules and benefit schedules.
• Strong stakeholder, vendor and executive engagement skills.
• People leadership, coaching, financial and project management capability.
• Excellent communication, report writing, presentation, judgement and complex problem-solving skills.

How to apply

If you are ready to take on this role, please send your CV to Sign in to view email:

• In the body of your email, please clearly state your current notice period.
• The subject line must strictly read: Application for: Senior Manager: Clinical Governance & Benefit Design

Please note

Due to the volume of applications received, only applications that fully comply with the above submission requirements will be considered during the shortlisting process.

POLMED reserves the right to fill this position on either a fixed-term or permanent basis, in line with organisational requirements.

If you do not hear from us within the next two weeks, please consider your application unsuccessful on this occasion.

Closing date: 12 October 2026.