Hospital Benefits Management Specialist - Pretoria, South Africa - Tych Business Solutions

Tych Business Solutions
Tych Business Solutions
Verified Company
Pretoria, South Africa

1 week ago

Thabo Mthembu

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Thabo Mthembu

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Description

Job ID: 58560
Date Posted: Posted 6 hours ago
Location: Pretoria, Gauteng
Job Title: HOSPITAL BENEFITS MANAGEMENT SPECIALIST - PERSONS WITH DISABILITIES - PRETORIA


Duties:


  • The Specialist is required to provide support to Manager for effective oversight of all managed care processes including:
All hospital pre-auth processes
All case management processes
Access to and utilisation of In lieu of hospitalisation benefits
Oversight of all relevant inter SPN integration processes
Other projects as defined and aligned to Scheme Strategy

  • Attend various Forums and contribute to effective strategic clinical and utilisation risk management.
  • Support the accurate and timeous roll out of all defined programmes.
  • Assist in the development and implementation of a quality assurance and utilisation review programme for hospital benefits.
  • Support the development, evaluation and revision of SOPs in relation to hospital benefits and clinical risk management.

Requirements:

  • 3year Degree, Diploma or NQF Level 6 Diploma/Degree in Medical/Clinical Sciences Qualification (Nursing qualification advantageous)
  • 46 years work experience in the healthcare funding/medical schemes industry
  • Solid Hospital Benefits and Disease Risk Management Operations experience with Medical Scheme operational insight
  • Be analytical and can manage priorities
  • Have excellent written and verbal communication and interpersonal skills
  • Critical thinking skills
  • Ability to work independently under pressure and as part of a team
  • Team player with good organisational skills
  • Adaptable and resilient
  • Project Management skills will be an added advantage
  • Proficient with MS Office Suite
  • Must be in possession of a valid driver's license and be willing to travel at short notice
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