Clinical Pre-Authorisation Consultant (Cape Town & Centurion) at Momentum

Role Purpose    

• To ensure that best practice is followed in providing Medical Care and treatment for members.

Qualifications

• Matric
• Enrolled or Registered Nurse essential
• 2-3 years experience within the managed care industry essential
• Excellent understanding of the scheme products and legislation
• Effective management of scheme rules in line with clinical guidelines
• Knowledge of PMB guidelines
• Telephonic etiquette

Duties & Responsibilities    

• Attain daily KPI of 50 calls a day to meet the prescribed number of calls (240 seconds handling time per call)
• Maintain quality customer service
• Bin management turn-around time of 48 hours
• Implementation of policies/protocols related to scheme benefits
• Benefits in and out of hospital is appropriately controlled
• Exclusions are correctly and consistently applied
• Positive relationships are built and maintained with hospitals and providers
• Appropriate referral to Case Management team

Competencies    

• Understands how the business operates, what the key issues and risks are that drives business success; and how they impact on the commercial viability of potential ventures and the profitability of the Group
• Anticipates, meets and exceeds client's needs by creating long lasting relationships that support the client value proposition, supports their financial wellness and ensures client centricity.
• Drive a sense of urgency, focus, accountability, agility and execution to deliver business results.
• Actively leads change, does what is right for the business and drives continuous improvement through innovation.
• Prioritises the business interests of MMH and invests in the success of the group by aligning effort across divisions.
• Persuades, convinces, influences and inspires others, both within MMH and externally to win support, loyalty and gain commitment to the purpose of MMH.
• Manages self and relationships with others effectively, deals with ambiguity, uncertainty and pressure, and provides perspective in difficult situations.
• Is sensitive to individual and cultural differences and demonstrates humility and an openness to engage people from diverse backgrounds and cultures to the mutual benefit of all parties concerned.

Closing Date: 25th, June 2022