Gauteng: Team Leader and Training Coordinator – Hospital Risk Management posted by Fusion Personnel

• Nursing qualification (Diploma/Degree) with SANC registration (essential).
• Experience in pre-authorisation, case management, and clinical auditing within a managed healthcare/medical scheme environment (essential).
• Technical proficiency in managed healthcare systems, case management modules, and claims processing.
• Previous training, coaching, or mentoring experience.
• Supervisory/leadership background in clinical risk management (advantageous).

Knowledge & Skills:

• Strong knowledge of ICD-10, CPT-4 coding, PMB legislation, tariffs, and scheme rules.
• Ability to identify non-chargeable and overcharged items in hospital accounts.
• Knowledge of adult learning principles and training methodologies (advantageous).

Key Responsibilities

• Team Leadership: Mentor and support staff, oversee workloads and SLA compliance, ensure quality standards, and deliver performance reports.
• Training Coordination: Design and deliver training programmes, conduct assessments, identify development needs, and align content with regulatory/industry changes.
• Clinical Governance & Systems: Handle complex clinical queries, ensure compliance in reconciliations, support data analysis and cost containment, and participate in system testing.
• Process Improvement & Communication: Update SOPs and processes, drive operational efficiency, maintain stakeholder relationships, and contribute to strategic initiatives.