Talent Pool : Wellness Coach Mmh251111-11

Momentum; Johannesburg; On-site; ZAR 200 000 - 300 000; Full time

Job summary

A healthcare service provider in Johannesburg is seeking a dedicated Registered Nurse to manage the quality and cost of clinical care. The ideal candidate will have a minimum of 5 years experience in Managed Care and hold a Registered Nurse certification. Responsibilities include liaising with patients and providers to improve health outcomes, managing care costs, and ensuring compliance with relevant clinical guidelines. This full-time role demands strong interpersonal skills and a commitment to client service delivery.

Qualifications

• Minimum of 5 years working experience within Managed Care.
• 3 years clinical practice as a registered nurse in the clinical setting.
• Knowledge of clinical guidelines and policies required.

Responsibilities

• Manage quality and cost of clinical and medical care.
• Co-ordinate interactions between various providers and patients.
• Ensure accurate application of acute case management protocols.

Skills

Registered Nurse

Health Coaching certification

Advanced Excel skills

Education

Registered or Enrolled Nurse Certification

Training as a Primary Care Nurse Practitioner

Job description

Role Purpose

The purpose of this role is to manage the quality and cost of clinical and medical care by liaising with members and providers.

Requirements

• Registered or Enrolled Nurse or Counsellor – Essential
• A Registered Nurse with the South African Nursing Council (SANC) – Essential
• Health Coaching certification – Advantageous

Experience

• Minimum of 5 years working experience within Managed Care – Essential
• 3 years clinical practice as a registered nurse in the clinical setting – Essential
• Training as a Primary Care Nurse Practitioner – Advantageous
• Experience in both HRM and DRM – Advantageous
• Experience as a home-based case nurse – Advantageous
• Experience in community health centre-based nursing care – Advantageous
• Experience as a registered nurse in a GP practice – Advantageous

Knowledge

• Advanced Excel skills
• Knowledge of prescribed minimum benefits basic principles
• Knowledge of managed care principles
• Knowledge of protocols and treatment plans
• Knowledge of pathology analysis
• Knowledge of the CDL conditions and the ICD10 codes
• Knowledge of preventative health benefits to manage health risks
• Knowledge of clinical guidelines and policies
• Knowledge of acute and chronic diseases, prevention, causes, and treatment
• Knowledge of anatomy and physiology

Duties and Responsibilities

PROCESS

• Prioritise work in accordance with required intensity of patient management
• Daily planning and organisation in accordance with allocated member
• Accountability for daily workload and required interventions
• Interaction with Patient, GP and Specialist and other providers including home-based and convalescent nurses
• Manage quality and cost of clinical and medical care by liaising with members and providers and manage the reduction of recurring costly events and medicine spend
• Work with individual consumers (beneficiaries and providers) of the scheme to achieve better health outcomes while helping beneficiaries to understand their disease(s) or health status
• Reduce the downstream clinical and financial risk associated with the beneficiary
• Co‑ordinate the required interactions between the various providers and hospitalist
• Keep detailed records of patient interaction and follow‑ups done by updating system records
• Ensure the effective, accurate and timely completion of relevant documentation accompanying transactions

Continued Medical Education task

• Manage cost of an in‑ or out‑patient episode by implementing appropriate policies and guidelines
• Arrange post‑hospital care where necessary
• Authorise appropriate and cost‑effective medical care and treatment
• Ensure the consistent and correct application of exclusions
• Adhere to policies and procedures and take corrective action where necessary
• Adhere to organisational best practice and legislative requirements
• Ensure accurate application of acute case management protocols

CLIENT

• Continuously monitor turnaround times and quality standards and resolve issues speedily to enhance client service delivery
• Drive client service delivery goal achievement in line with predefined standards to ensure clients receive appropriate advice and after‑sales service
• Manage client query processes and ensure queries are tracked, accurately resolved and used to improve client service and business processes
• Provide regular reports on delivery of services against agreed service level agreements and overall client targets
• Provide authoritative, expertise and advice to clients and stakeholders
• Build and maintain relationships with clients and internal and external stakeholders
• Contribute to the process of negotiating objective and realistic service level agreements, monitor appropriateness and recommend adjustments
• Deliver on service level agreements made with clients and internal and external stakeholders to ensure client expectations are managed
• Make recommendations to improve client service and fair treatment of clients within area of responsibility
• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service

PEOPLE

• Build strong relationships through providing specialist know‑how and leadership to others, expressing positive expectations
• Continuously develop own expertise in terms of industry and subject matter development and application thereof in an area of specialisation
• Positively influence and manage change and offer specialist support where required
• Contribute to continuous innovation through the development, sharing and implementation of new ideas and involvement of colleagues and staff

Seniority level: Mid‑Senior level

Employment type: Full‑time

Job function: Health Care Provider