Clinical Quality Assuror

2 days ago


Durban, 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.**Disclaimer**
- As an applicant, please verify the legitimacy of this job advert on our company career page.**Role Purpose**Requirements**:

- Senior certificate (Matric).
- 3 - 5 years call centre experience.
- 3 - 5 years managed health careexperience.
- Clinical Qualification (RegisteredNurse).
- Supervisory/ team leader experience will be an advantageous.
- Quality management experience will be an advantageous.

**Duties & Responsibilities**
- Assessment of clinical and non-clinical interactions (i.e. calls,correspondence and captures) of Case Managers, to measure thel evel of service provided to members and service providers
- Identifying and reporting of trends and training needs withthe focus on development of Metropolitan Health Risk Management Case Managers and administration assistants.
- Identifying and reporting of problem areas pertaining to the effectiveness of work flow systems to. Departmental Managers, to ensure system enhancements for improved service quality are initiated
- Develop best practice operating procedures to promote high quality output of work.
- Compiling weekly and monthly reports on assessment scores aswell as errors detected.
- Communicating regularly with the Programme Managers, Team Leaders and Case Managers andconduct feedback sessions in terms of assessment and quality checks being done.
- Coaching of Case Managers and administration assistants to achieve desired quality levels.
- Facilitating training sessions when required.
- Analyse member survey results and quality trends.
- Continuously stay abreast of developments in the business related to the Disease.
- Outcomes and Consolidated Treatment units.

**Competencies**
- Proven experience andunderstanding of scheme administration and the operationa lprocesses of the various. Managed Care Programmes.
- Proven analytical ability.
- Excellent communication,listening and interpersonal skills.
- Ability to liaise professionally and courteously at all levels.
- Pro-activeness and drive.
- Good decision making skills.
- Assertiveness
- Ability to work independently.
- Ability to work under pressure.
- Ability to remain and act neutral/impartial
- Ability to communicate recommendations in a constructive manner.


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