Team Leader Hospital Risk Management And Training Coordinator

Duties & Responsibilities

Team LeadershipLead, support, and mentor hospital risk management staff in clinical auditing, case management, and pre-authorisation functions. Maintain quality control over auditing and clinical risk assessments, providing regular feedback and coaching. Monitor workloads to ensure service level agreements (SLAs) are met. Resolve escalated queries, including complex hospital and provider account issues. Prepare and present departmental statistics and performance reports (daily, weekly, monthly, and quarterly).

Support HR processes, including performance counselling, change management, and succession planning. Act as a clinical subject matter expert and escalation point within the department.

Training CoordinationConduct recruitment assessments, competency testing, and first‑line interviews for departmental candidates. Develop, update, and maintain training materials, manuals, SOPs, and reference tools. Provide structured induction training to new staff on systems, clinical auditing, case management, and managed healthcare processes. Facilitate ongoing training and refresher sessions to address skills gaps and support staff development. Conduct post‑training assessments and provide detailed feedback during probation. Identify training needs and implement targeted development programmes. Submit regular training and development reports to management. Stay updated on industry trends, regulatory changes, and system enhancements to incorporate into training programmes.

Clinical Governance and System OversightLiaise with medical advisors, fund managers, providers, and members on complex clinical queries. Review and resolve complex account reconciliations, ensuring accuracy and compliance with scheme rules and CMS requirements. Contribute to data mining, trend analysis, cost containment, and disease management initiatives. Assist in preparing data for statutory returns to the Council for Medical Schemes. Participate in system testing and validate programming changes that impact clinical risk management. Identify staff with aptitude for testing and process improvement, mentoring them in advanced responsibilities.

Process Improvement and CommunicationReview and update SOPs, training materials, and cheat sheets in line with best practice and regulatory requirements. Identify and implement process improvements to enhance operational efficiency and accuracy. Ensure effective communication across departments and elevate issues promptly to senior management. Manage relationships with outsourced providers and other stakeholders. Provide input into strategic projects and ad hoc initiatives as required.

Desired Experience & Qualification

Education, Qualifications and Experience

Nursing Qualification (Diploma / Degree) with registration as a Professional Nurse with SANC (essential).

Previous experience in pre‑authorisation, case management, and clinical auditing within a managed healthcare / medical scheme environment (essential).

Proven technical proficiency in managed healthcare operating systems, case management modules, and claims processing. Prior training, coaching, or mentoring experience is required. Supervisory / leadership experience in a clinical risk management environment will be advantageous. 2.

Knowledge and Skills

Excellent command of the English language (spoken and written). Fluency in another South African language would be an advantage. Advanced computer literacy, including Microsoft Word, Excel, PowerPoint, and healthcare system applications. Strong telephonic and written communication skills. Analytical, logical thinker with sound problem‑solving skills. Excellent report‑writing, presentation, and facilitation skills. Strong knowledge of ICD-10, CPT‑4 coding, PMB legislation, tariffs, and scheme rules. Ability to identify and address non-chargeable and overcharged items in hospital accounts. Leadership and people management skills with a focus on coaching and staff development. Knowledge of adult learning principles and training methodologies (optional).

Interested?

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