HRm Team Leader: Chronic

20 hours ago

Durban, 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 work together with the Fund, Hospitals and all associated Service Providers to co-ordinate and monitor a Beneficiary's out of hospital benefits, Hospitalization and Post
- Hospitalization health care needs in order to manage quality and costs in line with clinical guidelines and protocols and intervene when appropriate.
Requirements
- Matric.
- Leadership or Management qualification.
- Previous chronic management experience is highly advantageous.
- Minimum 3 years’ experience in managed health care industry and financial services.
- Minimum 2 years supervisory experience in a service/chronic management environment.
- Strong knowledge of PMB legislation, Clinical Coding (NAPPI, ICD 10, CPT & NHRPL), Formularies, hospital and doctor’s billing guidelines is highly advantageous
Duties & Responsibilities
- Improve customer satisfaction by meeting all customer commitments in the delivery of the integrated value healthcare proposition of the schemes
- Supervising medicine risk, disease risk and prescribed minimum benefit.
- Performing regular quality assurance checks.
- Communicating the policies and procedures of the company to the team, ensuring that they are implemented and adhered to duly.
- Providing operational expertise.
- Speed up the time to resolution and ensure consistency of service delivery.
- Increase efficiency with tools that enable case managers/coaches to maintain and monitor cases and member journey experiences.
- Decrease number of manual processes and in-process time through workflow automation and consolidation of processes
- Improve service quality and customer satisfaction through the dissemination of knowledge and best practices - patient advocacy
- Accurate reporting to internal and external stakeholders
- Ensure that health risk management programmes meet cost containment criteria based on clinical protocols
- Adhere to the Service level agreements between the scheme and the administrator.
- Ensure that team functions optimally and in line with agreed upon key performance indicators
Competencies
- Understands how the business operates, what the key issues and risks are that drives business success; and how they impact on the commercial viability of potential ventures and the profitability of the Group
- Anticipates, meets and exceeds client’s needs by creating long lasting relationships that support the client value proposition, supports their financial wellness and ensures client centricity.
- Drive a sense of urgency, focus, accountability, agility and execution to deliver business results.
- Actively leads change, does what is right for the business and drives continuous improvement through innovation.
- Creates and maintains an open, positive working environment by generating commitment, building trust, a shared sense of purpose, empowerment in others and encouraging them to contribute to the best of their ability.
- Prioritises the business interests of MHS and invests in the success of the group by aligning effort across divisions.
- Persuades, convinces, influences and inspires others, both within MHS and externally to win support, loyalty and gain commitment to the purpose of MHS.
- Manages self and relationships with others effectively, deals with ambiguity, uncertainty and pressure, and provides perspective in difficult situations.
- Is sensitive to individual and cultural differences and demonstrates humility and an openness to engage people from diverse backgrounds and cultures to the mutual benefit of all parties concerned.
- Takes responsibility for own development; and actively mentors, coaches and develops talent in others. Builds leadership bench strength for MHS by providing opportunities and experiences to develop skills, competencies and business knowledge.
Enquiries
-

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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