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 by 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 PurposeTo work together with the Fund, Hospitals, and all associated Service Providers to coordinate 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.RequirementsMatricRegistered Nurse with Degree or Diploma (General, Psychiatric, and Midwife)Current registration with SANC, on applicationICU trained or experience would be advantageousMinimum 3 years' experience in the managed health care industryMinimum 2 years supervisory experience in a service environmentPrevious experience or knowledge of the managed healthcare industry and financial servicesStrong knowledge of PMB legislation, Clinical Coding (ICD 10, CPT & NHRPL), hospital and doctor's billing guidelines is highly advantageousStrong Oracle system knowledge is an advantageDuties & ResponsibilitiesImprove customer satisfaction by meeting all customer commitments in the delivery of the integrated value healthcare proposition of the schemesSupervise medicine risk, disease risk, prescribed minimum benefit, and hospital risk programmesPerform regular quality assurance checksCommunicate the policies and procedures of the company to the team, ensuring that they are implemented and adhered to dulyProvide operational expertiseSpeed up the time to resolution and ensure consistency of service deliveryIncrease efficiency with tools that enable case managers/coaches to maintain and monitor cases and member journey experiencesDecrease the number of manual processes and in-process time through workflow automation and consolidation of processesImprove service quality and customer satisfaction through the dissemination of knowledge and best practices - patient advocacyAccurate reporting to internal and external stakeholdersEnsure that health risk management programmes meet cost containment criteria based on clinical protocolsAdhere to the Service Level Agreements between the scheme and the administratorEnsure that the team functions optimally and in line with agreed-upon key performance indicatorsUnderstand 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 GroupAnticipate, meet, and exceed client's needs by creating long-lasting relationships that support the client value proposition, support their financial wellness, and ensure client centricityDrive a sense of urgency, focus, accountability, agility, and execution to deliver business resultsActively lead change, do what is right for the business, and drive continuous improvement through innovationCreate and maintain 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 abilityPrioritize the business interests of MHS and invest in the success of the group by aligning effort across divisionsPersuade, convince, influence, and inspire others, both within MHS and externally, to win support, loyalty, and gain commitment to the purpose of MHSManage self and relationships with others effectively, deal with ambiguity, uncertainty, and pressure, and provide perspective in difficult situationsBe sensitive to individual and cultural differences and demonstrate humility and an openness to engage people from diverse backgrounds and cultures to the mutual benefit of all parties concernedTake responsibility for own development; actively mentor, coach, and develop talent in others.
Build leadership bench strength for MHS by providing opportunities and experiences to develop skills, competencies, and business knowledge
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