Specialised Healthcare Coach

2 weeks ago

Durban, KwaZulu-Natal, South Africa Health Solutions Full time

Introduction


Momentum Health Solutions, an entity of Momentum Metropolitan Holdings 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.


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
  • 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 oncology is highly advabtageous.
  • 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 disease management programs
  • Maintaining relationships with 3rd parties
  • 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 costeffective 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 lifethreatening 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

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