Quality Assuror

-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
Requirements
- Matric certificate
- Registered Nurse with Degree or Diploma (General, Psychiatric, and Midwife)
- Current registration with the SANC
- Experience in private institutions, advantageous
- Minimum of 3 years clinical experience and in Managed healthcare/ Medical Aid industry
- Minimum 3 years Health Risk Management experience in Case Management/Wellness/Chronic/Disease Management, highly advantageous
- Strong knowledge of relevant Managed Healthcare legislation, SAMS Tariffs, Clinical coding (ICD 10, CPT & NHRPL) hospital and doctor’s billing guidelines, highly advantageous
- Quality management experience - advantageous
- Good knowledge of the Oracle system, highly advantageous
Duties & Responsibilities
- Assessment of clinical and non-clinical interactions (i.e., calls, correspondence and captures) of Case Managers, to measure the level of service provided to members and service providers.
- Identifying and reporting of trends and training needs with the focus on development of Metropolitan Health Risk Management Case Managers and administration assistants.
- Identifying and reporting of problem areas pertaining to the effectiveness of workflow 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 as well as errors detected.
- Communicating regularly with the Programme Managers, Team Leaders and Case Managers and conduct 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 as and 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 and understanding of scheme administration and the operational processes 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

Policy

We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.