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 organizations' 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

Manage quality and cost of clinical care by liaising with members and providers. Prevention of complications and high-cost admissions of all members. Provision of comprehensive and holistic guidance, support and management of potential high- risk members.

Requirements

Matric
Registered Nurse with Degree or Diploma (General, Psychiatric, Midwifery and Community) is essential.
Diploma and or experience in ICU and/or Midwifery will be an advantageous.
Current registration with SANC.
Training as Primary Care Nurse Practitioner will be an advantage
Minimum three years clinical practice in the discipline.
Experience in Health Risk Management, Case Management and Disease Risk Management will be advantageous.
Experience as a home-based care nurse will be an advantage.
Experience in Community Health Centre based nursing care will be an advantage.
Strong knowledge of PMB legislation, Clinical Coding (ICD 10, CPT & NHRPL), hospital and doctor's billing guidelines.

Duties & Responsibilities

Ensure alignment with the Wellness department needs and Wellness Coach role profile shared with you.
Priorities work in accordance with required intensity of patient management
Daily planning and organization in accordance with allocated member.
Accountability for daily workload and required interventions
Interaction with Patient, GP and Specialist and other providers including home based and convalescent nurses.
Manage quality and cost of clinical and medical care by liaising with members and providers and manage the reduction of recurring costly events and medicine spend.
Work with individual consumers (beneficiaries and providers) of the scheme to achieve better health outcomes while helping beneficiaries to understand their disease(s) or health status
Reduce the downstream clinical and financial risk associated with the beneficiary.o Co-ordinate the required interactions between the various providers and hospitalist
Keep detailed records of patient interaction and follow ups done by updating system records
Ensure the effective, accurate and timeous completion of relevant documentation accompanying transactions
Continued Medical Education task
Manage cost of an in or out- patient episode by implementing appropriate policies and guidelines.
Arrange post hospital care where necessary.
Authorize appropriate and cost- effective medical care and treatment
Ensure the consistent and correct application of exclusions.
Adhere to policies and procedures and take corrective action where necessary.
Adhere to organizational best practice and legislative requirements.
Ensure accurate application of acute case management protocols.

Competencies

Understands the elements of the value chain / proposition and understands the impact of external influences on the business.
By evaluating products, services and issues from the client's perspective gains an understanding of the clients need and focus on providing a positive client experience.
Client and stakeholder commitment
Drive a sense of urgency, focus, accountability, agility, and execution to deliver results. Looks for opportunities to performance in area.
Demonstrates openness to consider new ways of doing things and actively look to improve things.
Proactively shares information with others, give timeous feedback and fosters a trusting environment for open honest communication.
Identifies areas to partner on team initiatives to achieve joint or complementary goals. Builds trust and respect with people outside of his or her immediate team
Actively listen to the priorities and concerns of others. Tailor presentations to the audience.
Demonstrates high levels of self- awareness and acknowledges areas of strength and limitations. Behaves ethically and always treats colleagues with respect and dignity
Is sensitive to individual and cultural differences and demonstrates humility and an openness to engage people from diverse backgrounds and cultures to the mutual benefit of all parties concerned.
* Respects different viewpoints as being as valid as own. Understands the specific individual and cultural differences between regions or organizations.