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 provide leadership to clinical teams in achieving key performance indicators (KPIs), improving member health and claims outcomes, and delivering excellent service through a strong understanding of client needs, member health risk profiles and stakeholder requirements.
Requirements
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A National Senior Certificate is essential
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It is essential to have a General Nursing Diploma or Degree
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The incumbent must be registered with SANC (South African Nursing Council) as a Registered / Professional Nurse
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At least 3 – 5 years’ experience in a managed care/case management environment
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At least 3 – 5 years’ clinical experience within a private hospital is essential (ICU and theatre experience is advantageous)
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Experience in supervision and leadership of employees is advantageous
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Clinical auditing experience is advantageous
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Understanding of the medical scheme industry is essential
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MS 365 proficiency
Duties & Responsibilities
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Supervision of Case Managers and Auditing staff to ensure that the team achieves its mission and KPI's.
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Ensuring staff comply with all HR policies and procedures including but not limited to attendance, overtime approval, timekeeping, discipline, performance management and leave coordination.
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Training and communication to staff on benefits, rates, rules and company procedures.
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Assisting with all escalated case management and audit queries.
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Handling of complaints from Council for Medical Schemes received by the Fund Managers.
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Completing of the weekly operational and performance measurements for the team, analysing the stats and ensuring that the appropriate action is taken.
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Reporting of any system issues to IT proactively.
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Assisting the Fund Manager with collating of information and writing of reports for meetings if required.
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Case management and clinical auditing of accounts.
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Analysing workflow processes and ensuring that the processes are efficient and relevant.
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Ensuring that all reports are checked and actioned.
Competencies
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Excellent interpersonal skills and communication skills
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Ability and experience in supervision and leadership of employees
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Ability to think proactively and independently
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Ability to establish long term relationships with the various stakeholders
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Meticulous attention to detail
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Able to meet deadlines and work under pressure
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Ability to multitask and prioritise work
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Ability to work as part of a team
