Clinical Risk | Case Management Team Leader at Kaelo

Team Lead Specific Duties


Develop and maintain reports of daily activities, present analysis and feedback to the Clinical manager.
Perform monthly Quality Assurance Audits for the team.
Allocate daily roles and activities to team members based on demand and capacity.
Where applicable, ensure that the team are appropriately allocated to afterhours duties, and maintain a record of timesheets to be submitted to the line manager for remuneration of afterhours activities.
Ensure the team is meeting their specified SLA for all daily activities, where inefficiencies or issues are noted these must be raised to the line manager immediately.
Supervise and report on the clinical auditing of claims conducted by the team
Training and coaching the teams (including but not limited to: company policies and standards, product rules, clinical guidelines) to ensure high-quality clinical care management services are provided.
Training for Netcare 911 teams
Communicate with the Health Service Cantre Manager to ensure operational efficiencies between the Health Service Centre and Case Management team
Provide input and support for projects as required by the business


Daily operational activities

Case Management Team


Ensure team is correctly and accurately allocated to cover all shift s.
Assist team with Clinical decisions and escalations
Draft and update Clinical SOP's
Guide team on funding decision based on product differences
Review long term cases are correctly allocated and scheduled
Review High-Cost cases received weekly
Review report sent daily, weekly and monthly.


HIV Patient Management team


Check the maintenance of Service level
Train team on latest guidelines to medication and protocol
Update the SOP's
Review all Provider, system and patient escalations
Keep abreast with the latest guidelines


Administrative duties

Line management of Case Management and Patient Management team


monthly
Leave management
Refresher team Training and development
Quality auditing
Rostering and scheduling


General


Report any clinical escalations/concerns to the Clinical Review Committee or clinical risk management teams
Maintain confidentiality in clinical conditions shared with her/him.


Key outcomes


Assist the Clinical and Medical Advisors to identify appropriate resources and guidelines based on the latest trends to improve patient access to treatment and effective curative processes and care .
Ensure team maintain the correct standard of care with valid level of acuity and care at designated facilities.
Ensure all team members maintain current nursing skills and knowledge base by attendance at workshops and seminars, completion of mandatory continued professional development, reading of professional journals, publications, and participation in professional organizations.
Develop and maintain reports on the activities carried out within their team, presenting feedback and analysis of targets and outcomes.


Qualifications

EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY

REQUIRED


Professional Nurse / Registered Nurse / Enrolled Nurse / ALS paramedic
Degree / Diploma in Nursing
A minimum of 5 years nursing experience.
Experience across both the public and private health sector.
Medical Aid or Insurance industry experience will be an advantage.
Knowledge of ICD codes.


DESIRED


Hospital ICU and theatre experience.
PHC, Midwifery, and HIV experience is an advantage.
Knowledge of PMB and DTP's


TECHNICAL SKILLS OR KNOWLEDGE

REQUIRED


Strong understanding of clinical codes.
Attention to detail.
Health risk assessment knowledge.
Computer Literacy (Microsoft office).


Additional Information

PERSONAL ATTRIBUTES: BEHAVIORAL COMPETENCIES


Accountability for clinical decisions made.
Communication with all related health care workers, patient, and next of kin involved in a case.
Writing skills-for clear and concise notes that are easy to understand.
Efficient and effective mindset to make clear clinical decisions without prejudice and interfering personal beliefs.
Planning and organisation of work.
Resilient and adaptive to different environments.
Prioritizes patient care
Self-development