Specialised Healthcare Coach

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

Requirements

• Matric/Grade12

• Registered nurse (Nursing Diploma or Degree)

• Registered with the South African Nursing Counsel

• Three years clinical practice in the discipline.

• Experience with HIV/AIDS management, including providing education, counselling, care coordination to individuals living with HIV/AIDS is essential

• Experience in both HRM and DRM will be an advantage.

• Training as Primary Care Nurse Practitioner will be an advantage

• One year case management experience in a managed care environment will be an advantage

Duties & Responsibilities**(Internal Process)**

• Prioritise work in accordance with required intensity of patient management

• Daily planning and organization in accordance with allocated member.

• Accountability for daily work load 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.

• 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.

CLIENT

• Continuously monitor turnaround times and quality standards and resolve issues speedily to enhance client service delivery

• Drive client service delivery goal achievement in line with predefined standards in order to ensure that clients receive appropriate advice and after sales service.

• Manage client query processes and ensure that queries are tracked, accurately resolved and used as a mechanism to improve client service and business processes

• Provide regular reports on delivery of services against agreed service level agreements and in terms of overall client targets.

• Provide authoritative, expertise and advice to clients and stakeholders

• Build and maintain relationships with clients and internal and external stakeholders

• Contribute to the process of negotiating objective and realistic service level agreements, monitor appropriateness and recommend adjustments

• Deliver on service level agreements made with clients and internal and external stakeholders in order to ensure that client expectations are managed

• Make recommendations to improve client service and fair treatment of clients within area of responsibility

• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service

PEOPLE

• Build strong relationships through providing specialist know-how and leadership to others, expressing positive expectations.

• Continuously develop own expertise in terms of industry and subject matter development and application thereof in an area of specialisation.

• Positively influence and manage change and offer specialist support where required.

• Contribute to continuous innovation through the development, sharing and implementation of new ideas and involvement of colleagues and staff.

• Participate and contribute to a culture of work centric thinking, productivity, service delivery and quality management.

• Take ownership for driving career development.

FINANCE

• Contribute to the development of area specific budgets to minimise expenditure, in alignment with operational plans.

• Identify solutions to enhance cost effectiveness and increase operational efficiency.

• Implement and provide input into governance processes, systems and legislation within area of specialisation.

• Escalate unresolved policy and governance compliance issues via appropriate channels for investigation and resolution purposes

• Provide input into the risk identification processes development and communicate recommendations in the appropriate forum

Competencies****Business Acumen -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. Client/ Stakeholder Commitment - 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 for Results - Drive a sense of urgency, focus, accountability, agility and execution to deliver business results.

Leads Change and Innovation - Actively leads change, does what is right for the business and drives continuous improvement through innovation.

Collaboration - Prioritises the business interests of Momentum Health and invests in the success of the group by aligning effort across divisions.

Impact and Influence - Persuades, convinces, influences and inspires others, both within MMI and externally to win support, loyalty and gain commitment to the purpose of Momentum Health.

Self-Awareness and Insight - Manages self and relationships with others effectively, deals with ambiguity, uncertainty and pressure, and provides perspective in difficult situations.

Diversity and Inclusiveness - 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