Wellness Coach: Health4Me

at  Health Solutions

INTRODUCTION

Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximize lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.

REQUIREMENTS

• Matric
• Nursing Diploma or Degree
• Enrolled Nurse or Registered nurse is essential
• One year case management experience in a managed care environment
• Three years clinical practice in the discipline
• Experience in both hospital case management and/ or disease management (advantageous).
• Possess the applicable registration to the respective professional bodies as it is required by the medical schemes Act (Regulation 15D (1) (d)
• Knowledge of Momentum Health Administration system (advantageous)

ROLE PURPOSE

Manage quality and cost of clinical and medical care by liaising with members and providers.

DUTIES & RESPONSIBILITIES

• The aim of this position is to manage quality and cost of clinical and medical care by liaising with members and providers.
• Build strong relationships through providing specialist know-how and leadership to others, expressing positive expectations.
• Prioritise work in accordance with required intensity of patient and cost management.
• Daily planning and organisation in accordance with case load.
• Accountability for daily workload and required interventions.
• Interaction with member, GP and Specialist and other providers including home based and convalescent nurses.
• Manage quality and cost of clinical and medical care by liaising with medical providers, members and their families as well as other 3rd party service providers when need be.
• Work with individual consumers (beneficiaries and providers) of the Insurer to achieve better health outcomes while helping beneficiaries to understand their benefits, disease(s) or health status.
• Reduce the downstream clinical and financial risk associated with the beneficiary.
• Co-ordinate the required interactions between the various providers and hospitals
• Keep detailed records of patient interaction and follow-ups done by updating system records.Ensure the effective, accurate and timeous completion of relevant documentation accompanying transactions.
• Continued Medical Education of all role players.
• Manage cost of an in or out-patient episode by implementing appropriate policies and guidelines.Arrange post hospital care where necessary.
• Authorise appropriate and cost-effective medical care and treatment.
• Ensure the consistent and correct application of exclusions.
• Adhere to policies and procedures and take corrective action where necessary.
• Adhere to organisational best practice and legislative requirements.
• Ensure accurate application of acute case management protocols.
• Continuously monitor turnaround times and quality standards and resolve issues speedily to enhance client service delivery.
• Contribute to the development of area specific budgets to minimise expenditure, in alignment with operational plans.