TEAM LEADER AND TRAINING COORDINATOR HOSPITAL RISK MANAGEMENT at MEDICAL SCHEME

About the position

Key Performance Areas (KPAs)

• To Lead and transfer knowledge, include coaching, to the team within the
• Reporting, answering and resolving of escalation queries, planning and system management and testing

Responsibilities

• Maintain quality control for Clinical auditing staff and provide monthly feedback and stats to senior manager
• Provide clinical expertise within the organisation where required
• Referral of problems to the Medical advisor and Clinical Review team
• Liaising with Medical advisor, Scheme Fund manager and members
• Liaising with outsourced providers and suppliers
• Manage ad hoc clinical and system projects as required
• Review and update training manuals, guidelines, standard operating procedures (SOP's) and cheat sheets
• Responsible for identifying and updating system and process enhancements throughout the department
• Be a continuous source of expert information for staff as well as any system updates
• Regular submission of all reports with regards training and development, both internal and external
• Responsible for identifying and meeting training needs of existing staff
• Providing detailed training feedback post probation
• Provision of in-depth managed healthcare system training relevant to the position (new staff should arrive with the necessary clinical expertise relevant to the position they have been recruited for)
• Responsible for the training of all new staff recruits in the areas of clinical assessing/auditing, pre- authorisation and specialised case management
• Updating of current department assessments used during recruitment
• Conduct telephonic assessment, competency assessments and first line interviews during recruitment
• Monitor workload to ensure SLA's are met
• Involvement with any complex hospital/ associated account queries leading to resolution and reconciliation of the account
• Review of departmental Stats
• Assist with all HR issues ie: performance counselling, change management etc
• Escalate departmental issues to management
• System testing : Responsible for testing any system programming changes that affect the department and identify staff members who display an aptitude for testing and dreveloping their testing abilities
• Data Mining:Involvement with the data mining process from a statistical point of view within the areas of trends, costs and disease management, amongst others
• Review of data for the Annual statutory return of the scheme to Council for Medical schemes
• Working with other healthcare personnel within the organisation and liaising closely with the business liaison unit

QUALIFICTIONS
NURSING QUALIFICATION IS ESSENTIAL
3 TO 5 YEARS EXPERIENCE IN MANAGED HEALTHCARE

Desired Skills:

• MANAGED HEALTHCARE IS ESSENTIAL
• NURSING QUALIFICATION
• PRE AUTHORISATION AND CASE MANAGEMENT KNOWLEDGE