Reference Number MMH240902-4
Job Title Clinical Consultant x2
Position Type Permanent
Role Family Client Services
Cluster Health Solutions
Remote Opportunity None of the time
Location - Country South Africa
Location - Province KwaZulu-Natal
Location - Town / City Durban, Cornubia
Introduction
Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation, and create value through unique insights of 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
To ensure best practice is followed in providing medical care and treatment.
Requirements
- Matric.
- Registered Nurse is essential.
- 2-3 years experience within the managed care industry.
- Excellent understanding of thescheme products and legislation.
- Effective management of scheme rules in line with clinical guidelines.
- Knowledge of PMB guidelines.
- Telephonic etiquette.
- Attain daily KPI of 70 ;meet theprescribed number of calls (240seconds Handling time percall).
- Maintain quality customer service.
- Bin management turn- aroundtimeof 48 hours.
- Implementation ofpolicies/protocols related to scheme benefits.
- Benefits in and out of hospitalis appropriately controlled.
- Exclusions are correctly and consistently applied.
- Positive relationships are built and maintained with hospitals and providers.
- Appropriate referral to case management team.
- Understands how the business operates, what the key issues and risks are that drives business success; and how they impact on the commercial viability of potential ventures and the profitability of the Group.
- 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.
- Drive a sense of urgency, focus, accountability, agility and executionto deliver business results.
- Actively leads change, does what is right for the business and drives continuous improvement through innovation.
- Prioritises the business interests of MMH and invests in the success of the group by aligning effort across divisions.
- Persuades, convinces, influences and inspires others, both within MMH and externally to win support, loyalty and gain commitment to the purpose of MMH.
- Manages self and relationships with others effectively, deals with ambiguity, uncertainty and pressure, and provides perspective in difficult situations. 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.
