Ambulatory 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: 58557
Date Posted: Posted 6 hours ago
Location: Pretoria, Gauteng
Job Title: AMBULATORY BENEFITS MANAGEMENT SPECIALIST - PERSONS WITH DISABILITIES - PRETORIA


Duties:


  • Support the Scheme's strategic objectives and mandates in developing and implementing of Clinical Risk Management Platform in relation to access to outofhospital benefits and utilisation management.
  • Provide support to the Manager for effective oversight of all managed care processes including:
  • All out-of-hospital aPMB authorisation processes
  • All PMB query management processes (prospective and retrospective).
  • Oversight of the Disease Management Programmes (DMPs)
  • Oversight of the Value-Based Care programmes
  • Oversight of all relevant interSPN 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 rollout of all defined programmes.
  • Assist in developing and implementing a quality assurance and utilisation review programme for ambulatory benefits.
  • Support the development, evaluation, and revision of SOPs in relation to outofhospital benefits and clinical risk management. Perform tasks timeously, accurately and with necessary detail in response to issues raised

Requirements:


  • 3year Degree, Diploma or NQF Level 6 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
  • Organised and have good time management skills
  • Adaptable and resilient
  • Selfmotivated and proactive (selfstarter)
  • Must be in possession of a valid driver's license and be willing to travel at short notice
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