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HRM Team Leader

Vacancy Details

Reference No.

SP3-6073

Synopsis

Role Purpose To work together with the Fund, Hospitals and the all associated Service Providers to co-ordinate and monitor a Beneficiary's out of hospital benefits, Hospitalization and Post- Hospitalization health care needs in order to manage quality and costs in line with clinical guidelines and protocols and intervene when appropriate.

Description

  • Improve customer satisfaction by meeting all customer commitments in the delivery of the integrated value healthcare proposition of the schemes
  • Supervising medicine risk, disease risk, prescribed minimum benefit and hospital risk programmes
  • Performing regular quality assurance checks
  • Communicating the policies and procedures of the company to the team, ensuring that they are implemented and adhered to duly
  • Providing operational expertise
  • Speed up the time to resolution and ensure consistency of service delivery
  • Increase efficiency with tools that enable case managers/coaches to maintain and monitor cases and member journey experiences
  • Decrease number of manual processes and in-process time through workflow automation and consolidation of processes
  • Improve service quality and customer satisfaction through the dissemination of knowledge and best practices - patient advocacy
  • Accurate reporting to internal and external stakeholders
  • Ensure that health risk management programmes meet cost containment criteria based on clinical protocols
  • Adhere to the Service level agreements between the scheme and the administrator. 
  • Ensure that team functions optimally and in line with agreed upon key performance indicators

Requirements

  • Matric
  • Registered Nurse with Degree or Diploma (General, Psychiatric and Midwife).
  • Current registration with SANC, on application.
  • ICU trained or experience would be advantageous.
  • Minimum 2 years supervisory experience in a service environment.
  • Previous supervisory exposure in a managed healthcare environment would be highly advantageous.
  • Previous experience or knowledge of the managed healthcare industry and financial services
  • Strong knowledge of PMB legislation, Clinical Coding (ICD 10 , CPT & NHRPL), hospital and doctor's billing guidelines is highly advantageous

Please note that if you havent received feedback within 2 weeks, consider your application as unsuccessful 

Position Type

Permanent

Work Level

Mid-Level

Salary

Market Related

Industry

Pharmaceutical And Medical/Healthcare

Salary Type

Annually

Package

Cost To Company

Affirmative Action

No

Geographic Location

Kwazulu Natal - Durban