Team Leader Hospital Risk Management
Headhunt • Port Elizabeth, Eastern Cape, South Africa
3 days ago
Job description
Our client in the Financial Services and Insurance industry is seeking to employ a Team Leader: Hospital Risk Management to join their team based in Port Elizabeth.
Purpose of Role:
To lead and support clinical teams in achieving operational and quality performance targets to enhance member health and claims outcomes.
Requirements:
- Grade 12 / Matric is relevant
- General Nursing Diploma or Degree
- Must be registered with SANC (South African Nursing Council) as a Registered / Professional Nurse
- A minimum of 3 years experience in a managed care/case management environment
- A minimum of 3 years clinical experience within a private hospital is essential (ICU and theatre experience is advantageous)
- Prior leadership experience is advantageous
- Clinical Auditing experience is advantageous
- Good understanding of the Medical Scheme industry
- Proficient in Microsoft Office
Responsibilities:
- Lead and supervise the Case Management and Clinical Claims Auditing teams ensuring achievement of key performance indicators (KPIs) and service delivery
standards. - Ensure compliance with all company HR policies and procedures.
- Provide ongoing training guidance and communication to staff regarding benefits tariffs scheme rules and organisational policies and procedures.
- Support the resolution of complex and escalated case management and clinical audit queries.
- Manage and investigate complaints received from the Council for Medical Schemes (CMS) and liaise with Fund Managers to ensure effective resolution.
- Monitor analyse and report on weekly operational and performance metrics implementing corrective actions and continuous improvement initiatives where required.
- Assist Fund Managers with the compilation of information and preparation of reports and presentations for meetings and stakeholder engagements.
- Review and analyse workflow processes to identify efficiencies enhance productivity and ensure process relevance and effectiveness.
- Ensure all operational audit and performance reports are reviewed validated and appropriately actioned within agreed timelines.
Please note that if you do not receive a response within 2 weeks your application has been unsuccessful.
Required Experience:
Manager
Employment Type : Full-Time
Experience: years
Vacancy: 1