Team Leader Case Management

Lead a clinical team to achieve Service Level Agreements and targets. Manage financial and clinical risks through scheme rules and policies. Develop the team for sustained performance and growth. Build relationships with external stakeholders to apply rules and resolve queries or disputes.

Qualifications:

-Bachelor’s Degree (3 years) / NQF level 7, General Nursing / Management, computer literacy

Experience:

-            Case Management, Operational, 5 years

-            Management, Supervisory, 1 year is an advantage

Responsibilities:

• Maintain active and informative relations with all team members and colleagues.
• Adhere to statutory regulations, organisational standards, policies and procedures. Report non-compliance and implement corrective actions to ensure compliance.
• Ensure targets/objectives are met accurately as per SLA requirements
• Propose ideas or practical improvements relevant to tasks. Participate in improvement initiatives.
• Manage the operational performance of the team as per HR frameworks and policies to ensure delivery to agreed standards and objectives. Provide appropriate staff development, coaching and mentoring.
• Track and drive team to achieve and maintain defined service level agreements and turn-around times at the defined and approved quality standards
• Ensure compliance to all statutory medical guidelines, terms and conditions and scale of cost. Ensure claims are properly vetted and paid as per scheme rules resulting in no financial loss to the company. Ensure timely claims payment. Liaise with medical professionals for second opinions on complex cases
• Identify loopholes within your department and propose solutions for improvements.
• Come up with new ideas to improve process/Standard Operating Procedures.
• Manage and monitor leave liability.
• Attend to mails, complaints, and queries within 24 hours (Internal and External)
• Visits service providers as and when required.

Knowledge:

-            Health Care, 

-            Knowledge, application and improvement of policies and procedures

-            Health legislation and regulatory

Skills:

-            Communication, Problem Solving, Change Management, Innovation and risk taking, Time Management, Quality Orientation

Personal Attributes:

-            Action Orientated, Manage Complexity, Problem Solving Skills, Demonstrates self-awareness, Resilient and Adaptive