Job Description

Closing Date 2024/06/07
Reference Number MMH240531-2
Referral Platform URL
Job Title Talent Pool: Clinical Consultant ( Gauteng & Cape Town)
Position Type Permanent
Role Family Client Services
Cluster Health Solutions
Remote Opportunity None of the time
Location - Country South Africa
Location - Province Gauteng
Location - Town / City Gauteng & Cape Town
IntroductionMomentum Health Solutions, an entity of Momentum Metropolitan Holdings Limited delivers sustainable, integrated health solutions that meet the needs of clients in 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.
Role PurposeTo ensure the implementation of best practices and optimal medical care for members through expert clinical guidance, collaboration with healthcare professionals, and continuous improvement initiatives.
RequirementsQUALIFICATIONS

• A recognised medical degree (MBChB or equivalent)
• A nursing degree (Bachelor of Nursing Science or equivalent)
• 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 are essential.EXPERIENCE

• 3 - 5 years of experience as a registered nurse practitioner or equivalent experience.
• 3 - 5 years of experience within the healthcare industry.
• 2 - 3 years of experience within the managed care environment and/or healthcare consulting

industry would be advantageous.
Duties & ResponsibilitiesPROCESS

• 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 resolutionand improving operational efficiency, in accordance with key performance indicator specifications. * Implement policies and protocols related to scheme benefits to ensure consistent application andadherence, resulting in improved clarity and member satisfaction. * Ensure appropriate control of benefits in and out of the hospital by closely monitoring utilisation,resulting in cost-effective care while maintaining quality outcomes. * Apply exclusions correctly and consistently based on policy guidelines and regulatoryrequirements, ensuring fairness and accuracy in benefit coverage determinations.CLIENT

• 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.PEOPLE

• Appropriately refer cases to the case management team, ensuring members receive

comprehensive care coordination, resulting in improved health outcomes and member
satisfaction. * Collaborate with the case management team, leveraging clinical expertise to support and enhancetheir decision-making process, leading to optimal care plans and member well-being.FINANCE

• Monitor and manage healthcare utilisation and costs, optimising resource allocation and

maintaining financial sustainability while ensuring high-quality care. * Identify cost-saving opportunities and process improvements, contributing to improved financialefficiency and organisational effectiveness.
Competencies

• Analytical skills
• Communication skills (written and verbal)
• Critical thinking skills
• Decision-making skills
• Interpersonal skills
• Problem solving skills
• Research skills
• Organisational skills
• Time management skills
• Collaboration skills

PolicyWe are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.

Momentum Metropolitan