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 maximise 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.
Role Purpose
This position will report to the Medicine Risk Manager and is based in Cornubia. The successful candidate will be required to manage the registration request for Chronic conditions/ treatment, chronic related queries and to give support to the Health Risk Management team.
Requirements
- Matric
- Post Basic Pharmacist assistant qualification is essential
- Previous Health Risk Management experience would be an advantage
- Previous experience in a managed care environment dealing with Health Risk Management would be an advantage.
- Previous experience in a hospitalised environment is advantageous.
- Registration with the Pharmacy Council as Pharmacist Assistant is essential
- Clinical Knowledge
- Computer literate
- Good telephone etiquette.
Duties & Responsibilities
- All interactions, telephonic and written, with members, providers, brokers and internal stakeholders to be professional
- Registration of medicine and/or diagnosis to be done timeously and independently in accordance to MMI Health policies and scheme formularies
- Develop effective relationships and ensure that Service Level Agreements with External clients and internal departments are maintained thus ensuring excellent service to the scheme, members, providers as well as internally
- 24 hour turnaround —; Maintain a consistent and quality 24 hour turnaround time from receipt of documents/calls into the Medicine Risk Management department
- Provide 1st time and timeous resolution on queries.
- Provide effective management of a patients disease and lifestyle to promote an integrated and holistic approach to managing the healthcare of a member.
- To provide support and assistance to the DUR Pharmacist, DRM, HRM and Clinical Governance departments in terms of medical management and clinical.
- Ensure effective claims management service delivery and support
- Perform an efflcient and accurate administrative function to the team.
- Identify all compliance risks and bring to the attention of the team leader for review.
- Monitor customer delivery constraints and escalate to management
- Identify and investigate all possible non-disclosure of pre- existing conditions
- Identify the appropriate entry criteria and ensure consistent and correct authorizations in line with clinical policies and the relevant scheme rules and formularies.
- Have the capacity to develop oneself and others via the various training options thus positively growing oneself and the team.
Competencies
- Customer focused
- Excellent verbal and writtenc
- Communications Skills
- Good interpersonal skills
- Attention to detail
- Service oriented
- Stress tolerant and working underpressure.
- Empathetic
- Proactive
- Highly motivated
- Drive and support effective
$ads={2}
$ads={1}