Overview
Team Leader: Hospital Risk Management Jobs in Port Elizabeth, South Africa at Headhunters
Our client in the Financial Services and Insurance industry is seeking to employ a Team Leader:
Hospital Risk Management to join their team based in Port Elizabeth.
Purpose of Role: To lead and support clinical teams in achieving operational and quality performance targets to enhance member health and claims outcomes.
Requirements:
- Grade 12 / Matric is relevant
- General Nursing Diploma or Degree
- Must be registered with SANC (South African Nursing Council) as a Registered / Professional Nurse
- A minimum of 3 years’ experience in a managed care/case management environment
- A minimum of 3 years’ clinical experience within a private hospital is essential (ICU and theatre experience is advantageous)
- Prior leadership experience is advantageous
- Clinical Auditing experience is advantageous
- Good understanding of the Medical Scheme industry
- Proficient in Microsoft Office
Responsibilities:
- Lead and supervise the Case Management and Clinical Claims Auditing teams, ensuring achievement of key performance indicators (KPIs) and service delivery
standards. - Ensure compliance with all company HR policies and procedures.
- Provide ongoing training, guidance, and communication to staff regarding benefits, tariffs, scheme rules, and organisational policies and procedures.
- Support the resolution of complex and escalated case management and clinical audit queries.
- Manage and investigate complaints received from the Council for Medical Schemes (CMS) and liaise with Fund Managers to ensure effective resolution.
- Monitor, analyse, and report on weekly operational and performance metrics, implementing corrective actions and continuous improvement initiatives where required.
- Assist Fund Managers with the compilation of information and preparation of reports and presentations for meetings and stakeholder engagements.
- Review and analyse workflow processes to identify efficiencies, enhance productivity, and ensure process relevance and effectiveness.
- Ensure all operational, audit, and performance reports are reviewed, validated, and appropriately actioned within agreed timelines.
Please note that if you do not receive a response within 2 weeks, your application has been unsuccessful.
Title: Team Leader: Hospital Risk Management
Company: Headhunters
Location: Port Elizabeth, South Africa
Category: