Closing Date: 2024/09/19Reference Number: MMH240902-4Job Title: Clinical Consultant x2Position Type: PermanentRole Family: Client ServicesCluster: Health SolutionsRemote Opportunity: None of the timeLocation - Country: South AfricaLocation - Province: KwaZulu-NatalLocation - Town / City: Durban, CornubiaIntroduction:Momentum Health Solutions, an entity of Momentum Metropolitan Holdings, delivers sustainable, integrated health solutions that meet the needs of clients in different segments and maximize lifetime client value. We build and maintain a culture of innovation and create value through unique insights on how to achieve specific outcomes using a defined set of Health capabilities.Disclaimer: As an applicant, please verify the legitimacy of this job advert on our company career page.Role Purpose:To ensure best practice is followed in providing medical care and treatment.Requirements:Matric.Registered Nurse is essential.2-3 years' experience within the managed care industry.Excellent understanding of the scheme products and legislation.Effective management of scheme rules in line with clinical guidelines.Knowledge of PMB guidelines.Telephonic etiquette.Duties & Responsibilities:Attain daily KPI of 70 – meet the prescribed number of calls (240 seconds Handling time per call).Maintain quality customer service.Bin management turnaround time of 48 hours.Implementation of policies/protocols related to scheme benefits.Benefits in and out of hospital are appropriately controlled.Exclusions are correctly and consistently applied.Positive relationships are built and maintained with hospitals and providers.Appropriate referral to case management team.Competencies:Understands how the business operates, what the key issues and risks are that drive business success, and how they impact 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, support their financial wellness, and ensure client centricity.Drives 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.Prioritizes the business interests of MMH and invests in the success of the group by aligning effort across divisions.Persuades, convinces, influences, and inspires others, both within MMH and externally, to win support, loyalty, and gain commitment to the purpose of MMH.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.
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