Reference Number MMH241210-11
Job Title Clinical Consultant
Position Type Permanent
Role Family Client Services
Cluster Health Solutions
Remote Opportunity Some of the time
Location - Country South Africa
Location - Province Gauteng
Location - Town / City Centurion
Introduction
Momentum Health Solutions, anentity of Momentum MetropolitanHoldings Limited deliverssustainable, integrated healthsolutions that meet the needs ofclients in different segments andmaximise lifetime client value. Webuild and maintain a culture ofinnovation, and create valuethrough unique insights of how toachieve specific outcomes byusing a defined set of Healthcapabilities.
Disclaimer As an applicant, please verify the legitimacy of this job advert on our company career page.
Role Purpose
To ensure the implementation ofbest practices and optimal medicalcare for members through expert clinical guidance, collaborationwith healthcare professionals, andcontinuous improvementinitiatives.
Requirements
- A nursing Diploma or Bachelor of Nursing Science.
- Additional qualifications such as Nurse Practitioner (NP), Clinical Nurse Specialist- (CNS).
- Advanced Practice Nurse (APN), Certifications in critical care nursing, oncology nursing, paediatric nursing, or other relevant specialties - (essential).
- Enrolled or Registered Nurse withSANC - (essential).
- 3 - 5 years of experience as aregistered nurse practitioner or equivalent experience.
- 3 - 5 years of experience within thehealthcare industry - (advantageous).
- 2 - 3 years of experience within themanaged care environment and/orhealthcare consulting industry would be advantageous.
PROCESS
- Meet the daily key performance indicator for proactive communication with members, ensuring timely assistance and effectively meeting their needs.
- Optimize bin management turn around time, streamlining the process for prompt issue resolution and improving operational efficiency, in accordance with key performance indicator specifications.
- Implement policies and protocols related to scheme benefits to ensure consistent application and adherence, resulting in improvedclarity and member satisfaction.
- Ensure appropriate control of benefits in and out of the hospitalby closely monitoring utilisation, resulting in cost-effective care while maintaining quality outcomes.
- Apply exclusions correctly and consistently based on policy guidelines and regulatory requirements, ensuring fairness and accuracy in benefit coverage determinations.
- Maintain quality customer service by promptly addressing members' inquiries and concerns, resulting in enhanced member satisfaction and trust.
- Build and maintain positive relationships with relevant stakeholders (e.g., hospitals and providers), fostering effective collaboration and ensuring seamless coordination of care for members.
- Appropriately refer cases to the case management team, ensuring members receive comprehensive care coordination, resulting in improved healtho utcomes and member satisfaction.
- Collaborate with the case management team, leveraging clinical expertise to support and enhance their decision-making process, leading to optimal care plans and member well-being.
- Monitor and manage healthcareutilisation and costs, optimisingresource allocation and maintaining financial sustainabilitywhile ensuring high-quality care.
- Identify cost-saving opportunitiesand process improvements, contributing to improved financial efficiency and organisationaleffectiveness.
- Analytical skills.
- Communication skills (written andverbal).
- Critical thinking skills.
- Decision-making skills.
- Interpersonal skills.
- Problem solving skills.
- Research skills.
- Organisational skills.
- Time management skills.
- Collaboration skills.
