Clinical Consultant

2 weeks ago

Cape Town, Western Cape, South Africa Health Solutions Full time

Introduction


Momentum 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 Purpose


The successful incumbent will be responsible to ensure the implementation of best practices and optimal medical care for members through expert clinical guidance, collaboration with healthcare professionals, and continuous improvement initiatives.


Requirements:

QUALIFICATIONS

  • A recognised medical degree (MBChB or equivalent), OR
  • A nursing degree (Bachelor of Nursing Science or equivalent)
  • Additional qualifications such as Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), or
Advanced Practice Nurse (APN), Certifications in critical care nursing, oncology nursing, paediatric nursing, or
other relevant specialties are essential.

EXPERIENCE
years of experience as a registered nurse practitioner or equivalent experience.
years of experience within the healthcare industry.
years of experience within the managed care environment and/or healthcare consulting
industry would be advantageous.

Duties & Responsibilities

PROCESS

  • Meet the daily key performance indicator for proactive communication with members, ensuring
timely assistance and effectively meeting their needs.

  • Optimize bin management turnaround time, streamlining the process for prompt issue resolution
and improving operational efficiency, in accordance with key performance indicator specifications.
adherence, 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.
requirements, 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 enhance
their 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 costsaving opportunities and process improvements, contributing to improved financial
efficiency and organisational effectiveness.

Competencies

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

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