Job Description

Introduction

Momentum Health, an entity of Momentum Group ,delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximize lifetime client value. We build and maintain a culture of innovation, and create value through unique insights into how to achieve specific outcomes by using a defined set of Health capabilities.

Disclaimer

As an applicant, please verify the legitimacy of this job advert on our company career page.

Role Purpose

Ensure comprehensive clinical risk management training, mentoring, and skills development, aligning business processes and system capabilities to optimise service delivery and achieve departmental and individual objectives.

Requirements

Bachelor of Nursing (BN) degree or an equivalent related qualification
Certification in Train the Trainer, Coaching, Instructional Design, Adult Learning, or relevant field.
Registered Nurse with South African Nursing Council (SANC)
3 - 5 years' experience in health risk management and or equivalent relevant experience.
1 - 2 years' experience in operational coaching or training.

Duties & Responsibilities

PROCESS

Develop and implement effective clinical risk management training programs, ensuring compliance with departmental and individual objectives to meet client needs.
Provide mentorship and guidance to healthcare professionals, equipping them with the necessary skills to deliver quality clinical risk management services to clients.
Assess and align business processes and system capabilities to optimise service delivery and ensure client satisfaction in clinical risk management.
Monitor and improve turnaround times and quality standards, promptly addressing any issues to enhance client service delivery experience.
Track and resolve client queries, utilising them as opportunities to improve client service and streamline business processes.
Recommend improvements to enhance client service and ensure fair treatment of clients within the scope of responsibility.


CLIENT



Build and nurture strong relationships with clients, as well as internal and external stakeholders, fostering trust and collaboration.
Ensure timely and effective delivery on service level agreements (SLAs) applicable to clients and stakeholders, managing and meeting their expectations.
Provide recommendations to improve client service and ensure fair treatment of clients within your area of responsibility, striving for continuous enhancement.
Actively participate and contribute to a culture that values and promotes rewarding relationships, open feedback, and exceptional client service.
Continuously monitor turnaround times and quality standards, promptly identifying and resolving issues to enhance client service delivery experience.
Drive the achievement of client service delivery goals in alignment with predefined standards, ensuring clients receive appropriate advice and after-sales service.
Effectively manage client query processes, ensuring queries are tracked, accurately resolved, and utilised as opportunities to improve client service and streamline business processes.


PEOPLE



Demonstrate leadership by providing specialist knowledge and support to colleagues, fostering positive expectations, and empowering them to deliver exceptional client service.
Continuously develop expertise in the industry and subject matter, applying it effectively to address client needs and expectations.
Actively contribute to change management initiatives and offer specialist support when needed to ensure smooth transitions and minimal disruption to client services.
Foster a culture of continuous innovation by sharing and implementing new ideas that enhance client satisfaction and improve service delivery.
Embrace a work-centric mindset, emphasising productivity, service delivery, and quality management to meet client objectives.
Take ownership of driving career development for oneself and others, enabling individuals to grow and provide better service to clients.


FINANCE



Contribute to the development of area-specific budgets, aiming to minimise expenditure while aligning with operational plans and meeting client requirements.
Identify and propose cost-effective solutions to increase operational efficiency in clinical risk management, providing better value for clients.
Implement and provide input into governance processes, systems, and legislation relevant to the specialised area, ensuring compliance with client-related requirements.
Escalate unresolved policy and governance compliance issues through appropriate channels for investigation and resolution to safeguard client interests.
Provide input into the identification and communication of recommendations for risk management processes that protect client assets and ensure their well-being.


KNOWLEDGE



Clinical risk management principles, practices, and methodologies to effectively train and mentor healthcare professionals.
Understanding of Centers for Medicare and Medicaid Services (CMS) rules and guidelines to navigate reimbursement and billing processes effectively.
Regulatory frameworks and compliance requirements in clinical risk management.
International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) coding systems to accurately assign codes for diagnoses and procedures.
Creating and updating patient authorisations for incoming and outgoing services.
Understanding of business processes and their alignment with service delivery in clinical risk management.
Workflow optimisation, system capabilities, and process improvement methodologies.
Quality management frameworks and continuous improvement methodologies.
The National Health Reference Price List (NHRPL), previously known as the Board of Healthcare Funders (BHF) and the South African Medical Association (SAMA) tariffs.

Competencies

Developing Expertise
Articulating Information
Empowering Individuals
Adopting Practical Approaches
Challenging Ideas
Embracing Change
Interacting with People
* Making Decisions