Clinical Pre Auth Team Leader
4 weeks ago
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 PurposeThe aim of this position is to work together with the Fund, Hospitals and the Service Providers to co-ordinate and monitor a Beneficiary's in and out of hospital health care needs in order to manage quality and costs in line with clinical guidelines and protocols and intervene when appropriate.
Requirements Matric Registered nurse / BPharm with at least a minimum of 3 years' experience Registration with the professional bodies (SANC/SAPC) At least 3 years demonstrated experience in a Team Leader or leadership role advantageous Previous experience or knowledge of the healthcare industry, financial services, and insurance will an added advantage Knowledge of the Oracle system will be advantageous Duties & Responsibilities Maintain great staff morale by leading, guiding, developing and supporting team members by identifying appropriate training needs and providing coaching to achieve performance standards Liaise with trainers to ensure that their training material is accurate and continuously updated. Networks with other areas across the business Facilitates and manages projects, system enhancements and changes Positively influence and participate in change initiatives Continuously develop own expertise in terms of professional, industry and legislation knowledge Communicate the policy and procedures of the company to the team, ensuring that they are implemented. Increase efficiency with tools that enable staff to maintain and monitor cases in terms of quality and cost efficiencies. Supervise staff, including identification of training needs and requirements, granting leave, performance appraisals, and productivity (in terms of quality and quantity) in collaboration with the manager for assisting the manager in the development of the programs and staff. Compiling Health Risk Management (HRM) operational and scheme reports. Attend internal stakeholder and scheme clinical meetings where required Improve customer satisfaction by meeting all customer commitments and service provider requirements. Coaching and supporting the Managed care teams in ensuring a high standard of service delivery. Build and maintain relationships with clients and internal and external stakeholders. Deliver on service level agreements made with clients and internal and external stakeholders in order to ensure that client expectations are managed. Demonstrate exemplary leadership behaviour, through personal involvement, commitment and dedication in support of organizational values. Execute effective workforce planning practices to ensure that staffing requirements are accurately forecasted. Identify solutions to enhance cost effectiveness and increase operational process efficiency across managed care programmes. Implement and provide input into governance processes, systems and legislation within area of specialization. Provide input into the risk identification processes development and communicate recommendations in the appropriate forum. Competencies Business Acumen Advanced Excel skills Report writing skills Client /Stakeholder Commitment Drive for Result Leads change and innovation Motivating and Inspiring team Self-awareness and insight Diversity and inclusiveness Growing talent Enquiriessiphesihle.zulu@momentum.co.za-
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