Product Support Specialist

• Feb 2021 - Present

Bridge between all stakeholders and the organisation's IT development environment, to ensure the needs and requirements of stakeholders are developed on the system. To ensure these enhancements are delivered accurately. To ensure Business Improvement and implementation.

Team Leader: Hospital Case Management

• Jun 2020 - Jan 2021

Manage clinical and non-clinical resources in relation to hospitalization, rendering a quality and efficient service to both internal and external stakeholders.

Team Leader: Pre-authorisation

• Feb 2018 - May 2020

High Level Query Consultant

• May 2017 - Jan 2018

Dealing with escalated queries received via various channels, social media, management, CMS and the Scheme, related to Hospital Benefit Management.Identifying trends and providing input to relevant stakeholders to prevent re-occurence.

Team Leader: Clinical Audit (fixed term contract)

• Aug 2016 - Apr 2017

The opportunities presented at Medscheme have been invaluable. I have been exposed to other areas within the managed care arena, in a team leader capacity, which included hospital case management, as well as the pre-authorization contact centre.

Team leader: Clinical Audit and Technical Specialists

• Mar 2014 - Jul 2016

My role profile has changed a few times over the past 3 years, within the company. Last year March, my team was extended to include the Technical Specialists. This also resulted in me moving away from the Third Party environment. The technical specialist are responsible for ensuring that the medical scheme rules, tariffs and master files are loaded, tested and maintained on the operating system. The role challenges me daily and I am learning all of the time. Having gone through one year end in 2014 has provided me with a wealth of knowledge and insight. I am most satisfied in a role that constantly challenges me; and where I am using all of my skills, be it analyzing, planning,organizing, leading, supervising, meeting deadlines, focused on exceeding client(internal and external) expectations, to name a few. Show less

Team Leader Third Parties and Clinical Audit

• Jan 2013 - Mar 2014

Operational support to Medical Scheme (client)

Team Leader: Clinical Audit and PMB

• Apr 2012 - Dec 2012

Manage clinical support audit, PMB and quality assurance resources and processes.Identify system and process enhancement that will ensure efficiencies.Identify trends with regard to clinical audit, escalations and quality assurance results and implement corrective actions where necessary.

Team Leader: Disease Management

• Aug 2009 - Mar 2012

Manage DM case managersAssist with implementation of DM programmeCo-ordinate wellness daysManaging and resolving high level escalations

DRM Case Manager

• Nov 2008 - Jul 2009

Telephonic assessment of members clinical status and risk profileTelephonic case managementEnsuring effective management of the treatment plan benefits

Team Leader Client Centric

• Mar 2008 - Oct 2008

Management of Case Managers, DUR pharmacists and facilitators in relation to hospitalization, chronic medication, disease management and prescribed minimum benefits as well as the related benefits provided to the scheme. Management of Case Managers, DUR pharmacists and facilitators in relation to hospitalization, chronic medication, disease management and prescribed minimum benefits as well as the related benefits provided to the scheme.

DRM case manager

• 2006 - 2007

Key Performance Areas: • Telephonic assessment of patient's current clinical status and risk profile • Defining desired clinical outcomes for the patient and prevent re-admission to hospital • Compiling, or utilising a preauthorised care plan for the patient to achieve the defined clinical outcomes • Telephonic case management and resolution of resultant queries within service levels • Managing and resolving high level or escalated queries • Evaluating patients progress at predetermined intervals and referring when appropriate • Investigating problems and high cost cases (hospital and chronic cases) • Meeting departmental goals and targets • Optimum management of the Disease benefits • Compiling projects and training material relative to the departmental work processes • Staff training (MHG and Qualsa) –PMB and DRM • Monitor staff performance related to productivity and quality. • Ensure that targets set for the team are met. • Ensure effective upward and downward communication between the team and management structures. • Maintain a high level of staff motivation within the team. • Interaction and networking with management team regarding operational issues in line with succession planning Show less

Theatre Scrub Sister

• 1997 - 2003