Momentum Health Solutions, an entity of Momentum Metropolitan Holdings, delivers sustainable, integrated health solutions that meet the needs of clients in different segments and maximize lifetime client value. We build and maintain a culture of innovation and create value through unique insights on how to achieve specific outcomes by using a defined set of health capabilities.
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Role Purpose
To work together with the Fund, Hospitals, and all associated Service Providers to coordinate and monitor a Beneficiary's out-of-hospital benefits, hospitalization, and post-hospitalization health care needs in order to manage quality and costs in line with clinical guidelines and protocols and intervene when appropriate.
Requirements
- Matric
- Registered Nurse with Degree or Diploma (General, Psychiatric, and Midwife)
- Current registration with SANC, on application
- ICU trained or experience would be advantageous
- Minimum 3 years’ experience in the managed health care industry
- Minimum 2 years supervisory experience in a service environment
- Previous experience or knowledge of the managed healthcare industry and financial services
- Strong knowledge of PMB legislation, Clinical Coding (ICD 10, CPT & NHRPL), hospital and doctor’s billing guidelines is highly advantageous
- Strong Oracle system knowledge is an advantage
Duties & Responsibilities
- Improve customer satisfaction by meeting all customer commitments in the delivery of the integrated value healthcare proposition of the schemes
- Supervise medicine risk, disease risk, prescribed minimum benefit, and hospital risk programmes
- Perform regular quality assurance checks
- Communicate the policies and procedures of the company to the team, ensuring that they are implemented and adhered to duly
- Provide operational expertise
- Speed up the time to resolution and ensure consistency of service delivery
- Increase efficiency with tools that enable case managers/coaches to maintain and monitor cases and member journey experiences
- Decrease the number of manual processes and in-process time through workflow automation and consolidation of processes
- Improve service quality and customer satisfaction through the dissemination of knowledge and best practices - patient advocacy
- Accurate reporting to internal and external stakeholders
- Ensure that health risk management programmes meet cost containment criteria based on clinical protocols
- Adhere to the Service Level Agreements between the scheme and the administrator
- Ensure that the team functions optimally and in line with agreed-upon key performance indicators
- Understand how the business operates, what the key issues and risks are that drive business success, and how they impact the commercial viability of potential ventures and the profitability of the Group
- Anticipate, meet, and exceed client’s needs by creating long-lasting relationships that support the client value proposition, support their financial wellness, and ensure client centricity
- Drive a sense of urgency, focus, accountability, agility, and execution to deliver business results
- Actively lead change, do what is right for the business, and drive continuous improvement through innovation
- Create and maintain an open, positive working environment by generating commitment, building trust, a shared sense of purpose, empowerment in others, and encouraging them to contribute to the best of their ability
- Prioritize the business interests of MHS and invest in the success of the group by aligning effort across divisions
- Persuade, convince, influence, and inspire others, both within MHS and externally, to win support, loyalty, and gain commitment to the purpose of MHS
- Manage self and relationships with others effectively, deal with ambiguity, uncertainty, and pressure, and provide perspective in difficult situations
- Be sensitive to individual and cultural differences and demonstrate humility and an openness to engage people from diverse backgrounds and cultures to the mutual benefit of all parties concerned
- Take responsibility for own development; actively mentor, coach, and develop talent in others. Build leadership bench strength for MHS by providing opportunities and experiences to develop skills, competencies, and business knowledge
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