Specialised Health Care Coach

2 weeks ago


Cape Town, South Africa Momentum Metropolitan Holdings 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.

Role Purpose

To manage clinical risk of patients through the authorisation of clinically appropriate treatment and outbound interventions.

**Requirements**:

- Matric
- Nursing Diploma or Degree (General Nursing, Psych, Maternity and Community Nursing) essential
- Minimum of 4 years clinical experience essential (including 2 years Maternity or Psych or Oncology or Community Nursing experience)
- Registered with SANC essential
- Experience in managed health care would be advantageous

Duties & Responsibilities
- Liaising with patients, providers and Disease Management companies
- Answering and assisting with all queries related to disease management programmes (Maternity, Renal, Psych, Oncology and other chronic conditions)
- Following up on decisions with Providers and/or 3rd parties
- Maintaining relationships with 3rd parties
- Monitoring the progress of patients on Disease Management Programmes.
- Assisting with early detection programmes and advocating available preventative health benefits to better manage risk
- Facilitating reports to the Scheme
- Initiating outbound contact with patients and providers where appropriate
- Educating and guiding all members regarding health care and their benefits
- Authorising appropriate and cost effective medical care and treatment
- Possible identification of Clinical Guidelines
- Identifying all Compliance Risks
- Supporting budget control and cost containment of Health Management Programmes
- Assisting with registration on various programmes to ensure quality of life for patients with life threatening diseases
- Dealing promptly with client requests in a competent, efficient and professional manner
- Liaising with specialists to gain their insight into assessing risks

Competencies
- Accountability
- Planning
- Organising and Attention to Detail
- Customer orientation
- Empathy
- People skills
- Teamwork and Co-operation
- Business Administration
- Results Orientation

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.



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