The purpose of this job is to manage and maintain databases and internal quality systems to ensure that treatment units achieve their quality standards and objectives.
Requirements
- Matric is essential
- Registered Nurse or Pharmacy Degree is essential
- Registration with South African Pharmacy Council is essential
- Registration with South African Nursing Council is essential
- 3 - 5 years pre-authorisation and managed health care experience
- Quality management experience
- Proven experience and knowledge of scheme administration and the operational processes of the various Qualsa Programmes (i.e. Health Risk Management (HRM), Oncology, Maternity, Disease Risk Management (DRM).
INTERNAL PROCESS
- Assisting with clinical and non-clinical interactions of Case Managers to measure the level of service provided to members and service providers.
- Identifying and reporting of trends, training needs, and facilitating training when required.
- Identifying and reporting of problem areas pertaining to the effectiveness of workflow systems to Head of Department.
- Develop best practice operating procedures to promote high quality output of work.
- Compiling weekly and monthly reports on assessment scores as well as errors detected.
- Regular engagements with Programme Managers, Team Leaders and Case Managers and conduct feedback sessions in terms of assessment and quality checks.
- Liaise with all relevant role players in the event of disputes regarding customer satisfaction measures in order to ensure the accurate and consistent application of procedures.
- Training of Case Managers and Administration Assistants to achieve desired quality levels.
- Analyse member survey results and quality trends and submit findings to Team Leader.
- Continuously stay abreast of developments in the business and industry related to Disease Management.
- Build and maintain relationships with clients, internal and external stakeholders.
- Deliver on service level agreements applicable to clients, internal and external stakeholders in order to ensure that 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.
- 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 in order to ensure that clients receive appropriate advice and service.
- Manage client query processes and ensure that queries are tracked, accurately resolved and used as a mechanism to improve client service and business processes.
- 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.
- Participate and contribute to a culture of work centric thinking, productivity, service delivery and quality management.
- Take ownership for driving career development
- Identify solutions to enhance cost effectiveness and increase operational efficiency.
- Implement and provide input into governance processes, systems and legislation within area of specialisation.
- Escalate unresolved policy and governance compliance issues via appropriate channels for investigation and resolution purposes.
- Provide input into the risk identification processes development and communicate recommendations in the appropriate forum.
