Health Risk Manager Mozambique

Momentum Group Limited

About The Position

Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members. The purpose of this role is to provide and manage a cost-effective Managed Health Care programme that promotes the appropriate utilisation of private healthcare facilities while controlling healthcare costs and ensuring quality patient outcomes.

Requirements

Medical Doctor qualification and professional registration
3–5 years' clinical and case management experience
Knowledge of managed healthcare and healthcare systems
Strong communication, analytical and problem-solving skills
Compassionate, organised and client-focused approach

Responsibilities

Coordinate post hospital care where necessary aligned to business practices and product rules.
Educate and guide all members regarding health care and their benefits to enhance understanding and satisfaction with their health care solution.
Develop, implement and communicate the practice and/or the clinical guidelines for cost effective care.
Authorise appropriate and cost-effective medical care and treatment aligned with product and business procedures.
Implement and monitor programs to manage and reduce the high costs of hospitalization whose diagnosis is associated with chronic diseases.
Efficiently implement and monitor the chronic disease management program.
Ensure the consistent and correct application of exclusions.
Adhere to policies and procedures and take corrective action where necessary.
Adhere to organisational best practice and legislative requirements.
Take ownership of escalated and unresolved queries and ensure they are resolved timeously and effectively.
Manage the problem until resolution, updating the incident detail with any status updates.
Ensure the effective, accurate and timeous completion of relevant documentation accompanying transactions.
Manage cost of an in or out-patient episode by implementing appropriate policies and guidelines.
Identify financial and business risks to the company and escalate accordingly.
Provide clients with in-depth product information.
Communicate with providers to improve the cost efficiencies of health care delivery.
Provide clear communication to all parties involved in an investigation with regards to the outcomes and process.
Ensure Service Level Agreements are met and exceeded.
Manage quality and cost of clinical and medical care by liaising with members and providers and manage the reduction of recurring costly events and medicine spend.
Take the extra mile and interact with patients to keep track of their progress and to ensure satisfaction.
Record cases information, complete accurately all necessary forms and produce statistical reports.