Wellness Coach: Health4Me at Momentum Metropolitan Holdings Limited

Role Purpose    

• Manage quality and cost of clinical and medical care by liaising with members and providers.

Requirements    

• Matric
• Nursing Diploma or Degree
• Enrolled Nurse or Registered Nurse is essential
• One year case management experience in a managed care environment
• Three years clinical practice in the discipline
• Experience in both hospital case management and/ or disease management (advantageous).
• Possess the applicable registration to the respective professional bodies as it is required by the medical schemes Act Regulation 15D (1) (d)
• Knowledge of Momentum Health Administration system (advantageous)

Duties & Responsibilities    

• The aim of this position is to manage quality and cost of clinical and medical care by liaising with members and providers.
• Build strong relationships through providing specialist know-how and leadership to others, expressing positive expectations.
• Prioritise work in accordance with required intensity of patient and cost management.
• Daily planning and organisation in accordance with case load.
• Accountability for daily work load and required interventions.
• Interaction with member, GP and Specialist and other providers including home based and convalescent nurses.
• Manage quality and cost of clinical and medical care by liaising with medical providers, members and their families as well as other 3rd party service providers when need be.
• Work with individual consumers(beneficiaries and providers) of the Insurer to achieve better health outcomes while helping beneficiaries to understand their benefits, 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 hospitals
• Keep detailed records of patient interaction and follow-ups done by updating system records.
• Ensure the effective, accurate and timeous completion of relevant documentation accompanying transactions.
• Continued Medical Education of all role players.
• 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 a cute case management protocols.
• Continuously monitor turn around times and quality standards and resolve issues speedily to enhance client service delivery.
• Contribute to the development of area specific budgets to minimise expenditure, in alignment with operational plans

Competencies    

• High standards of personal integrity, honesty and respect for confidentiality and feedback to clients.
• Be 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.
• Manages self and relationships with others effectively, deals with ambiguity, uncertainty and pressure, and provides perspective in difficult situations.
• Understands how the business operates, what the key issues and risks are that drives business success.
• 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
• Persuades, convinces, influences and inspires others, both within Momentum Group and externally to win support,loyalty and gain commitment to the purpose of Momentum Group.
• Drive a sense of urgency, focus, accountability, agility and execution to deliver business results.
• Prioritises the business interests of Momentum Group and invests in the success of the group by aligning effort across divisions.
• Actively leads change, does what is right for the business and drives continuous improvement through innovation.
• Presence and flexibility in the wellness coaching process.
• Prepared to take accountability for the relationship with the beneficiary.
• Sensitive and open-minded.
• Ability to express the patient roadmap clearly and succinctly.
• Analytical and able to identify and interact on relevant and important questions and aspects as are important to the beneficiary.
• High levels of responsibility and discernment about own role in the patient management cascade.
• Good level of clinical competencies.
• Synthesizing and analytical skilled relevant to the clinical requirements of interaction with beneficiaries that have higher levels of complexity of clinical needs clinical needs.

Closing Date    

• 2026/06/25