Job Description

Introduction

Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members.

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 - Essential
Registered Nurse with South African Nursing Council (SANC) - Essential
Certification in Train the Trainer, Coaching, Instructional Design, Adult Learning, or relevant field is Desirable
3 - 5 years experience in health risk management and or equivalent relevant experience.
1 - 2 years experience in operational coaching or training.


Knowledge



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.
Clinical risk management principles, practices, and methodologies to effectively train and mentor healthcare professionals.
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.

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.

Competencies

Customer engagement skills
Organisational awareness skills
Presentation skills
Business coaching skills
Mentoring skills
* Communication skills (written and verbal)