Talent Pool: Clinical Quality Assurer MMH251111-6

Talent Pool: Clinical Quality Assurer MMH -6 Momentum Johannesburg, Gauteng, South Africa Role Purpose The purpose of this job is to manage and maintain databases and internal quality systems to ensure that treatment units achieve their quality standards and objectives. Requirements Matric is essential Registered Nurse or Pharmacy Degree is essential Registration with South African Pharmacy Council is essential Registration with South African Nursing Council is essential 3 - 5 years pre-authorisation and managed health care experience Quality management experience Proven experience and knowledge of scheme administration and the operational processes of the various Qualsa Programmes (i.e. Health Risk Management (HRM), Oncology, Maternity, Disease Risk Management (DRM)). Duties and Responsibilities Internal Process Assisting with clinical and non-clinical interactions of Case Managers to measure the level of service provided to members and service providers. Identifying and reporting of trends, training needs, and facilitating training when required. Identifying and reporting of problem areas pertaining to the effectiveness of workflow systems to Head of Department. Develop best practice operating procedures to promote high quality output of work. Compiling weekly and monthly reports on assessment scores as well as errors detected. Regular engagements with Programme Managers, Team Leaders and Case Managers and conduct feedback sessions in terms of assessment and quality checks. Liaise with all relevant role players in the event of disputes regarding customer satisfaction measures in order to ensure the accurate and consistent application of procedures. Training of Case Managers and Administration Assistants to achieve desired quality levels. Analyse member survey results and quality trends and submit findings to Team Leader. Continuously stay abreast of developments in the business and industry related to Disease Management. Client Build and maintain relationships with clients, internal and external stakeholders. Deliver on service level agreements applicable to clients, internal and external stakeholders in order to ensure that client expectations are managed. Make recommendations to improve client service and fair treatment of clients within area of responsibility. Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service. Continuously monitor turnaround times and quality standards and resolve issues speedily to enhance client service delivery. Drive client service delivery goal achievement in line with predefined standards in order to ensure that clients receive appropriate advice and service. Manage client query processes and ensure that queries are tracked, accurately resolved and used as a mechanism to improve client service and business processes. People Build strong relationships through providing specialist know-how and leadership to others, expressing positive expectations. Continuously develop own expertise in terms of industry and subject matter development and application thereof in an area of specialisation. Positively influence and manage change and offer specialist support where required. Contribute to continuous innovation through the development, sharing and implementation of new ideas and involvement of colleagues and staff. Participate and contribute to a culture of work centric thinking, productivity, service delivery and quality management. Take ownership for driving career development. Finance Identify solutions to enhance cost effectiveness and increase operational efficiency. Implement and provide input into governance processes, systems and legislation within area of specialisation. Escalate unresolved policy and governance compliance issues via appropriate channels for investigation and resolution purposes. Provide input into the risk identification processes development and communicate recommendations in the appropriate forum. Seniority level Entry level Employment type Full-time Job function Human Resources #J-18808-Ljbffr