Job Description

Introduction

Momentum Health, an entity of Momentum Group 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

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Role Purpose

To manage clinical risk of patients through the authorisation of clinically appropriate treatment and outbound interventions.

Requirements

Matric
Degree or Diploma in Nursing (General, Psychiatric, Community) and Midwifery
Current registration with SANC, on application.
Minimum of 3 years clinical experience essential.
Minimum 3 years' experience in Managed Health Care Industry.
Experience in the management of chronic diseases is essential.
Experience in renal dialysis, organ transplant, psychiatry or oncologyis highly advantageous.
Strong knowledge of PMB legislation, Clinical Coding (ICD 10,CPT & NHRPL), hospital and doctor's billing guidelines is advantageous.

Duties & Responsibilities

Liaising with patients, providers and Disease Management companies.
Answering all queries related to Oncology, Renal dialysis and Organ Transplant, HIV and Mental Health disease programmes and 26 Chronic Disease Lists.
Follow up decisions with Providers and/or 3rd parties.
Monitoring the progress of patients on all diseasemanagement programs.
Maintaining relationships with 3rdparties.
Assisting with early detection programmes and advocating available preventative health benefits to better manage risk.
Facilitating reports to 3rd parties and the schemes.
Initiating outbound contact with patients and providers where appropriate.
Identifying and developing Clinical Guidelines and policies.
Authorising appropriate and cost-effective medical care and treatment.
Participating in the identification of clinical guidelines.
Researching, designing and developing material relevant to promoting awareness of health promotions e.g. Focus pages
Identifying all compliance risks
Educating and guiding all members regarding health care and their benefits.
Supporting budget control and cost containment of health management programmes
Assisting with registration on various programmes to ensure the quality of life for patients with life-threatening diseases
Dealing promptly with client requests in a competent, efficient and professional manner
Liaising with specialists to gain their insight into assessing risks
Communicating with providers to improve the cost efficiencies of healthcare delivery

Competencies

Accountability
Planning
Organization and attention to detail
Customer orientation
Empathy
People skills
Teamwork and Cooperation
Business Administration
* Results Orientation