Clinical Consultant X6 Mmh240902-4

Momentum Metropolitan Holdings Limited; Gauteng; On-site; ZAR 300,000 - 500,000; Full time

Job summary

An established industry player is seeking a dedicated Registered Nurse to provide exceptional medical care within the managed care sector. This role emphasizes the importance of maintaining high standards in client interactions and ensuring compliance with clinical guidelines. You will be responsible for managing relationships with healthcare providers, implementing policies, and driving continuous improvement. If you are passionate about healthcare and eager to make a positive impact, this opportunity offers a platform to excel in a dynamic environment focused on client-centric solutions and innovation.

Qualifications

• Registered Nurse with 2-3 years' experience in managed care.
• Strong understanding of scheme products and legislation.

Responsibilities

• Achieve daily KPI of 70 calls and maintain quality customer service.
• Build and maintain positive relationships with hospitals and providers.

Skills

Telephonic etiquette

Understanding of scheme products and legislation

Knowledge of PMB guidelines

Effective management of scheme rules

Education

Matric

Registered Nurse

Job description

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 Purpose

To ensure best practice is followed in providing medical care and treatment.

Requirements

1. Matric.
2. Registered Nurse is essential.
3. 2-3 years' experience within the managed care industry.
4. Excellent understanding of the scheme products and legislation.
5. Effective management of scheme rules in line with clinical guidelines.
6. Knowledge of PMB guidelines.
7. Telephonic etiquette.

Duties & Responsibilities

1. Attain daily KPI of 70 – meet the prescribed number of calls (seconds handling time per call).
2. Maintain quality customer service.
3. Bin management turnaround time of 48 hours.
4. Implementation of policies/protocols related to scheme benefits.
5. Benefits in and out of hospital are appropriately controlled.
6. Exclusions are correctly and consistently applied.
7. Build and maintain positive relationships with hospitals and providers.
8. Appropriate referral to case management team.
9. Understand 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.
10. Anticipate, meet, and exceed clients' needs by creating long-lasting relationships that support the client value proposition, financial wellness, and ensure client centricity.
11. Drive a sense of urgency, focus, accountability, agility, and execution to deliver business results.
12. Actively lead change, do what is right for the business, and drive continuous improvement through innovation.
13. Prioritize the business interests of MMH and invest in the success of the group by aligning effort across divisions.
14. Persuade, convince, influence, and inspire others, both within MMH and externally, to win support, loyalty, and gain commitment to the purpose of MMH.
15. Manage self and relationships with others effectively, deal with ambiguity, uncertainty, and pressure, and provide perspective in difficult situations.

Be sensitive to individual and cultural differences and demonstrate humility and openness to engage people from diverse backgrounds and cultures to the mutual benefit of all parties concerned.