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.

Disclaimer

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

Role Purpose

To assist in the enhancement and management of cost-effective managed health care with the objective of promoting rational utilisation of health care facilities and containing associated costs generated by these services.

Requirements

A National Senior Certificate is essential
It is essential to have a Nursing Diploma or Degree
Minimum of 1 year's clinical experience within a private hospital
The incumbent must be registered with SANC (South African Nursing Council) as a Registered / Professional Nurse
Experience in a managed care / case management environment would be an advantage
MS 365 proficiency

Duties & Responsibilities

Review of in-hospital patients for appropriateness of care, length of stay and level of care.
Liaise with the service provider on clinical updates, as well as outstanding information.
Engage with the treating doctor(s) to ensure appropriate treatment, length of stay and level of care is rendered.
Discharge planning for in-hospital patients to ensure ongoing support and care post discharge.
Develop, implement and communicate the practice and/or clinical guidelines for cost effective care.
Authorise appropriate and cost-effective surgical care and treatment.
Ensure the consistent and correct application of exclusions.
Adhere to policies and procedures and take corrective action where necessary.
Adhere to organisational best practice and legislative requirements.
Take ownership of escalated and unresolved queries and ensure they are resolved timeously.
Manage queries until resolution and update the incident details.
Identify financial and business risks to the company and escalate accordingly.
Provide clinical support to non-clinical team's if/when required.
Drive and support effective teamwork within the department.
Strive to demonstrate the company's values daily.
Engage in hospital visits where needed to build stakeholder relationships, proactively resolve queries and increase visibility to members.
Ensure the effective, accurate and timeous completion of relevant documentation and recording of interventions.
Communicate with providers to improve the cost efficiencies of health care delivery.
Ensure Service Level Agreements are met and exceeded.
Continuously develop own expertise in terms of industry and subject matter development and application thereof in an area of specialisation.

Competencies

Effective communication skills - verbal and written
Accountability
Planning and organising
Problem solving
Time management
Attention to detail
Interpersonal skills
Customer orientation
Results driven
Empathetic nature
* Business administration skills