Talent Pool: Clinical Governance Researcher MMH251118-12

1 week ago

Sandton, South Africa Momentum Full time

Talent Pool: Clinical Governance Researcher MMH Join to apply for the Talent Pool: Clinical Governance Researcher MMH role at Momentum . Role Purpose Ensure that stakeholders are given the correct information within the Clinical Governance function. Qualifications Matric (Essential) Nursing qualification (Essential) Healthcare accredited course (Desirable) Minimum of 5 years Clinical experience Registered with the SANC Minimum 3 years medical aid industry knowledge Pharmacology knowledge Computer literate and competent in Word / Excel Knowledge of Oracle system (workflow, association of documents) an advantage Good understanding of the medical scheme rules and regulations including PMB Knowledge of new medical technology Good Written and oral communication skills Duties and Responsibilities PROCESS Manage all complex clinical cases and requests for additional information from providers and members. Research all data available regarding a request / appeal. Make clinically appropriate decisions pertaining to letter of motivation from providers. Deal with member and doctor queries. Document decisions (update Workflow). Telephonic resolution of queries where applicable. Answer queries referred by Contact Centre, Pre-Authorisation, Scheme office and fund management, members and providers. Produce stats and reports required by the schemes. CLIENT Investigate client queries within the agreed service level and ensure that client receives timely feedback. Escalate client queries to the relevant department or stakeholder. Provide regular reports on delivery of services against agreed service level agreements and in terms of overall customer targets. Provide authoritative, expertise and advice to clients and stakeholders. Build and maintain relationships with clients and internal and external stakeholders. Deliver on service level agreements made with clients and 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. PEOPLE Develop and maintain productive and collaborative working relationships with peers and stakeholders. Positively influence and participate in change initiatives. Continuously develop own expertise in terms of professional, industry and legislation knowledge. Contribute to continuous innovation through the development, sharing and implementation of new ideas. Take ownership for driving career development. FINANCE Contribute to the financial planning process within area. Identify opportunities to enhance cost effectiveness and increase operational efficiency. Manage financial and other company resources under your control with due respect. Provide input into the risk identification processes and communicate recommendations in the appropriate forum. Job Details Seniority level: Mid-Senior levelEmployment type: Full-timeJob function: Research, Analyst, and Information Technology #J-18808-Ljbffr

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