To assist in the enhancement and management of a cost-effective managed Health Care with the objective of promoting rational utilisation of Health Care facilities and containing associated costs generated by these services.
Requirements
- Matric is essential
- Basic Diploma in Nursing (Enrolled Nurse) or Nursing Diploma or Degree is essential
- Registered with SANC (South African Nursing Council) is Essential
- Minimum of 3-5 years of working experience within managed care or acute hospital environment is essential
- Minimum of 5 years working experience within managed care is essential
- Experience in Hospital Risk Management is desirable
- Experience in private institutions is desirable
- Good understanding of the medical aid industry i.e.trends, competitors, and legislation is essential
- Must be computer literate
- Arrange post-hospital care where necessary.
- Educate and guide all members regarding health care and their benefits.
- Develop, implement and communicate the practice and/orthe clinical guidelines for cost-effective care.
- Authorise appropriate and cost-effective surgical 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 practices and legislative requirements.
- Take ownership of escalated and unresolved queries and ensure they are resolved timeously.
- Manage the problem until resolution, updating the incident detail with any status updates.
- Ensure the effective, accurate, and timeous completion of relevant documentation accompanying transactions.
- Communicate with providers to improve the cost efficiencies of health care delivery.
- Provide clear communication with regard to the outcomes and process.
- Ensure Service Level Agreements are met and exceeded.
- Engage in effective communication and delivery according to Service Level Agreements.
- Adhere to all procedures and processes to improve service delivery.
- Manage the cost of an in or out-patient episode by implementing appropriate policies and guidelines.
- Identify financial and business risks to the company and escalate accordingly.
- Drive and support effective teamwork within the department.
- Engage in appropriate training interventions to promote own professional development.
- Ensure to demonstrate the company's values on a daily basis.
