Team Leader: Hospital Risk Management

Role Purpose

To provide leadership to clinical teams in achieving key performance indicators (KPIs), improving member health and claims outcomes, and delivering excellent service through a strong understanding of client needs, member health risk profiles and stakeholder requirements.

Requirements

• A National Senior Certificate is essential
• It is essential to have a General Nursing Diploma or Degree
• The incumbent must be registered with SANC (South African Nursing Council) as a Registered / Professional Nurse
• At least 3 – 5 years’ experience in a managed care/case management environment
• At least 3 – 5 years’ clinical experience within a private hospital is essential (ICU and theatre experience is advantageous)
• Experience in supervision and leadership of employees is advantageous
• Clinical auditing experience is advantageous
• Understanding of the medical scheme industry is essential
• MS 365 proficiency

Duties and Responsibilities

• Supervision of Case Managers and Auditing staff to ensure that the team achieves its mission and KPI's.
• Ensuring staff comply with all HR policies and procedures including but not limited to attendance, overtime approval, timekeeping, discipline, performance management and leave coordination.
• Training and communication to staff on benefits, rates, rules and company procedures.
• Assisting with all escalated case management and audit queries.
• Handling of complaints from Council for Medical Schemes received by the Fund Managers.
• Completing of the weekly operational and performance measurements for the team, analysing the stats and ensuring that the appropriate action is taken.
• Reporting of any system issues to IT proactively.
• Assisting the Fund Manager with collating of information and writing of reports for meetings if required.
• Case management and clinical auditing of accounts.
• Analysing workflow processes and ensuring that the processes are efficient and relevant.
• Ensuring that all reports are checked and actioned.

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