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

Manage quality and cost of clinical and medical care by liaising with members and providers.

Requirements

Matric
Nursing Diploma or Degree
Enrolled Nurse or Registered Nurse is essential
One year case management experience in a managed care environment
Three years clinical practice in the discipline
Experience in both hospital case management and/ or disease management (advantageous).
Possess the applicable registration to the respective professional bodies as it is required by the medical schemes Act Regulation 15D (1) (d)
Knowledge of Momentum Health Administration system (advantageous)

Duties & Responsibilities

The aim of this position is to manage quality and cost of clinical and medical care by liaising with members and providers.
Build strong relationships through providing specialist know-how and leadership to others, expressing positive expectations.
Prioritise work in accordance with required intensity of patient and cost management.
Daily planning and organisation in accordance with case load.
Accountability for daily work load and required interventions.
Interaction with member, GP and Specialist and other providers including home based and convalescent nurses.
Manage quality and cost of clinical and medical care by liaising with medical providers, members and their families as well as other 3rd party service providers when need be.
Work with individual consumers(beneficiaries and providers) of the Insurer to achieve better health outcomes while helping beneficiaries to understand their benefits, disease(s) or health status.
Reduce the downstream clinical and financial risk associated with the beneficiary.
Co-ordinate the required interactions between the various providers and hospitals
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 of all role players.
Manage cost of an in or out-patient episode by implementing appropriate policies and guidelines.
Arrange post hospital care where necessary.
Authorise 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 organisational best practice and legislative requirements.
Ensure accurate application of a cute case management protocols.
Continuously monitor turn around times and quality standards and resolve issues speedily to enhance client service delivery.
Contribute to the development of area specific budgets to minimise expenditure, in alignment with operational plans

Competencies

High standards of personal integrity, honesty and respect for confidentiality and feedback to clients.
Be 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.
Manages self and relationships with others effectively, deals with ambiguity, uncertainty and pressure, and provides perspective in difficult situations.
Understands how the business operates, what the key issues and risks are that drives business success.
Anticipates, meets and exceeds client's needs by creating long lasting relationships that support the client value proposition, supports their financial wellness and ensures client centricity
Persuades, convinces, influences and inspires others, both within Momentum Group and externally to win support,loyalty and gain commitment to the purpose of Momentum Group.
Drive a sense of urgency, focus, accountability, agility and execution to deliver business results.
Prioritises the business interests of Momentum Group and invests in the success of the group by aligning effort across divisions.
Actively leads change, does what is right for the business and drives continuous improvement through innovation.
Presence and flexibility in the wellness coaching process.
Prepared to take accountability for the relationship with the beneficiary.
Sensitive and open-minded.
Ability to express the patient roadmap clearly and succinctly.
Analytical and able to identify and interact on relevant and important questions and aspects as are important to the beneficiary.
High levels of responsibility and discernment about own role in the patient management cascade.
Good level of clinical competencies.
Synthesizing and analytical skilled relevant to the clinical requirements of interaction with beneficiaries that have higher levels of complexity of clinical needs clinical needs.