Momentum Health Solutions
Company Overview:
Momentum Health Solutions, a division of Momentum Metropolitan Holdings, provides integrated and sustainable health solutions. Our aim is to meet diverse client needs across various segments while maximizing lifetime client value. We foster a culture of innovation and leverage specialized health capabilities to achieve targeted outcomes.
Role Purpose:
As a Professional Nurse: Case Manager, you will enhance and manage a cost-effective managed health care system. Your role will focus on promoting rational use of healthcare facilities and controlling associated costs.
Location:
- Country: South Africa
- Province: Eastern Cape
- Town/City: Gqeberha
Requirements:
- Education: National Senior Certificate.
- Qualifications: Nursing Diploma or Degree.
- Experience: Minimum of 2 years clinical experience within a private hospital.
- Registration: Must be registered with the South African Nursing Council as a Registered Nurse.
- Additional: Certificate in ICD-10 coding is highly advantageous. Experience in managed care or case management environment is a plus.
- Skills: Proficiency in MS Office / Office 365.
Duties & Responsibilities:
- Review in-hospital patients for appropriateness of care, length of stay, and level of care.
- Liaise with service providers on clinical updates and outstanding information.
- Engage with treating doctors to ensure appropriate treatment and care.
- Plan discharge for in-hospital patients to ensure ongoing support and care post-discharge.
- Develop, implement, and communicate clinical guidelines for cost-effective care.
- Authorize appropriate and cost-effective surgical care and treatment.
- Ensure consistent and correct application of exclusions.
- Adhere to policies and procedures, taking corrective action when necessary.
- Manage escalated and unresolved queries until resolution.
- Identify financial and business risks and escalate accordingly.
- Provide clinical support to non-clinical teams as needed.
- Support effective teamwork within the department and demonstrate the company’s values.
- Conduct hospital visits to build stakeholder relationships and resolve queries.
- Ensure accurate and timely completion of documentation and interventions.
- Communicate with providers to improve cost efficiencies in healthcare delivery.
- Ensure Service Level Agreements are met and exceeded.
- Continuously develop expertise in industry and specialization.
Competencies:
- Effective communication skills (verbal and written).
- Accountability and problem-solving.
- Planning, organizing, and time management.
- Attention to detail and interpersonal skills.
- Customer orientation and results-driven.
- Empathetic nature and business administration skills.
- Apply now at…https://momentummetropolitan.erecruit.co/candidateapp/Jobs/View/MMH240715-1
