Quality Assessor - HRM/DRM (Registered Nurse)

Position: Quality Assessor - HRM/DRM
Location: Cape Town
REF: MVG/RNQA
 
Large Managed Care organisation seek to employ a Quality Assessor to manage the assessment of the clinical and non-clinical interactions of their Case Managers and measure the level of service provided to members and service providers. Reports to the Service Manager.
 
Key Responsibilities:
  • Identify and report on trends and training needs for HRM Case Managers and administration assistants
  • Identify and report on the effectiveness of workflow systems to Department Managers to ensure system enhancements for improved service quality are initiated
  • Weekly and monthly reporting on assessment scores
  • Regular internal communication with Programme Managers, Team Leaders and Case Managers - feedback sessions wrt assessment and quality checks completed  
  • Coaching of Case Managers   
Key Requirements:
  • Registered Nurse currently registered with SANC
  • At least 1 year in Quality Management within a Managed Care environment
  • At least 4 years Managed Care experience with a minimum of 2 years in HRM Case Management  
  • High PC Literacy and working knowledge of call centre applications
  • Excellent understanding of scheme administration and operational processes within HRM and DRM (Oncology, Maternity, Lifestyle)
  • Advanced Excel ability and Oracle Administration System experience  
To apply submit application to response@mvgrecruitment.co.za.
 
Supporting documentation required:
    • Copy of Matric Certificate
    • Copy of Nursing Degree
    • Copy of current Registration with relevant industry body (SANC)
    • Comprehensive CV detailing your QA HRM/ DRM experience