Clinical Consultant x5

Clinical Consultant x5 – High-Paying Health Services Job

Closing Date: 18 February 2025
Reference Number: MMH240902-4
Position Type: Permanent
Role Family: Client Services
Cluster: Health Solutions
Remote Opportunity: None
Location: Centurion, Gauteng, South Africa

About Momentum Health Solutions
Momentum Health Solutions, a part of Momentum Metropolitan Holdings, offers integrated health solutions designed to meet client needs across different segments while maximizing lifetime client value. We foster a culture of innovation, using insights to achieve specific outcomes by applying a defined set of health capabilities. Learn more at www.momentum.co.za.

Role Purpose
As a Clinical Consultant, you will ensure best practices in providing medical care and treatment. You will work to manage scheme rules effectively while maintaining high-quality customer service and contributing to the ongoing success of Momentum Health Solutions.

Minimum Requirements

• Matric (Essential)
• Registered Nurse qualification (Essential)
• 2-3 years’ experience within the managed care industry
• Strong understanding of scheme products and relevant legislation
• Effective management of scheme rules in alignment with clinical guidelines
• Knowledge of PMB (Prescribed Minimum Benefits) guidelines
• Excellent telephonic etiquette

Key Responsibilities
Customer Service & Call Management

• Achieve daily KPI of 70 calls with an average handling time of 240 seconds per call.
• Maintain quality customer service through effective communication and care.
• Manage bin turnaround times of 48 hours for processing claims.

Clinical & Benefits Management

• Implement policies and protocols related to scheme benefits.
• Ensure that benefits in and out of hospital are properly controlled and exclusions are applied consistently.
• Build and maintain positive relationships with hospitals and providers.
• Ensure appropriate referrals to the case management team.

Compliance & Efficiency

• Maintain accurate knowledge and management of clinical guidelines.
• Ensure compliance with industry standards and PMB guidelines.
• Ensure that exclusions are applied correctly and consistently.

Key Competencies & Skills

• Strong understanding of business operations and the healthcare industry
• Ability to meet client needs and maintain long-term relationships
• Proactive in driving results with a sense of urgency, accountability, and focus on execution
• Ability to lead change, implement continuous improvement, and drive innovation
• Excellent interpersonal skills, including sensitivity to cultural differences
• Ability to manage relationships effectively, particularly under pressure

Why Join Momentum Health Solutions?

• Opportunity to work with one of South Africa’s leading health services providers
• Competitive salary and benefits with career growth potential
• Exposure to cutting-edge health solutions and clinical practices
• Be part of a culture of innovation and client-centric solutions

Employment Equity Commitment
Momentum is an Equal Opportunity Employer committed to Employment Equity. We encourage applicants from all backgrounds, including candidates with disabilities, to apply.

Apply Now & Advance Your Career in Health Services with Momentum!

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