Jobs at Momentum

Role Purpose    
Manage quality and cost of clinical care by liaising with members and providers. Prevention of complications and high-cost admissions of all members. Provision of comprehensive and holistic guidance, support and management of potential high-risk members.

Requirements    

• Matric
• Registered Nurse with Degree or Diploma (General, Psychiatric, Midwifery and Community).
• Current registration with SANC.
• Training as Primary Care Nurse Practitioner will be an advantage
• Minimum three years clinical practice in the discipline.
• Experience in Health Risk Management, Case Management and Disease Risk Management will be advantageous.
• Experience as a home-based care nurse will be an advantage.
• Experience in Community Health Centre based nursing care will be an advantage.
• Strong knowledge of PMB legislation, Clinical Coding (ICD 10, CPT & NHRPL), hospital and doctor's billing guidelines.

Duties & Responsibilities    

• Ensure alignment with the Wellness department needs and Wellness Coach role profile shared with you.
• Priorities work in accordance with required intensity of patient management
• Daily planning and organization 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 timeous 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.
• Authorize 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 organizational best practice and legislative requirements.
• Ensure accurate application of acute case management protocols.

Competencies    

• Understands the elements of the value chain / proposition and understands the impact of external influences on the business.
• By evaluating products, services and issues from the client's perspective gains an understanding of the clients need and focus on providing a positive client experience.
• Client and stakeholder commitment
• Drive a sense of urgency, focus, accountability, agility, and execution to deliver results. Looks for opportunities to performance in area.
• Demonstrates openness to consider new ways of doing things and actively look to improve things.
• Proactively shares information with others, give timeous feedback and fosters a trusting environment for open honest communication.
• Identifies areas to partner on team initiatives to achieve joint or complementary goals. Builds trust and respect with people outside of his or her immediate team
• Actively listen to the priorities and concerns of others. Tailor presentations to the audience.
• Demonstrates high levels of self-awareness and acknowledges areas of strength and limitations.
• Behaves ethically and always treats colleagues with respect and dignity
• 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.
• Respects different viewpoints as being as valid as own.
• Understands the specific individual and cultural differences between regions or organizations that influence local dynamics, workplace, or opportunities

Closing Date: 16th, June 2022