Ambulatory Benefits Management Specialist
2 weeks ago
**Job ID**: 58557**Date Posted**: Posted 6 hours ago**Location**: Pretoria, Gauteng**Job Title**: AMBULATORY BENEFITS MANAGEMENT SPECIALIST - PERSONS WITH DISABILITIES - PRETORIA
**Duties**:
- Support the Scheme’s strategic objectives and mandates in developing and implementing of Clinical Risk Management Platform in relation to access to out-of-hospital benefits and utilisation management.
- Provide support to the Manager for effective oversight of all managed care processes including:
- All out-of-hospital aPMB authorisation processes
- All PMB query management processes (prospective and retrospective).
- Oversight of the Disease Management Programmes (DMPs)
- Oversight of the Value-Based Care programmes
- Oversight of all relevant inter-SPN integration processes.
- Other projects as defined and aligned to Scheme Strategy
- Attend various Forums and contribute to effective strategic clinical and utilisation risk management.
- Support the accurate and timeous rollout of all defined programmes.
- Assist in developing and implementing a quality assurance and utilisation review programme for ambulatory benefits.
- Support the development, evaluation, and revision of SOPs in relation to out-of-hospital benefits and clinical risk management. Perform tasks timeously, accurately and with necessary detail in response to issues raised
**Requirements**:
- 3-year Degree, Diploma or NQF Level 6 in Medical/Clinical Sciences Qualification
(Nursing qualification advantageous)
- 4-6 years work experience in the Healthcare funding/Medical Schemes industry
- Solid Hospital Benefits and Disease Risk Management Operations experience with Medical Scheme operational insight
- Be analytical and can manage priorities
- Have excellent written and verbal communication and interpersonal skills
- Critical thinking skills
- Ability to work independently under pressure and as part of a team
- Team player with good organisational skills
- Adaptable and resilient
- Project Management skills will be an added advantage
- Proficient with MS Office Suite
- Organised and have good time management skills
- Adaptable and resilient
- Self-motivated and pro-active (self-starter)
- Must be in possession of a valid driver’s license and be willing to travel at short notice
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