Clinical Team Leader (HBM)

To lead and manage a team of professionals responsible for hospital pre authorisations and/or case management, ensuring accurate, clinically appropriate, and cost effective decision making. The role ensures adherence to clinical guidelines, medical necessity criteria, and effective clinical risk management, while optimizing patient outcomes and resource utilisation.

Minimum of 2 to 3 years relevant managed care, health risk and clinical customer service within Medical Scheme Administration Industry or similar. Previous exposure in managing a Clinical team will be advantageous.

• Nursing qualification with SANC registration/enrolment (mandatory)
• Strong knowledge of scheme rules, coding, and managed care protocols

• Analyse and provide client specific and business reports
• Defined legal, statutory and regulatory compliance is appropriately implemented and maintained at the required standards for the team
• Implemented team operational risk and governance structures, measures and frameworks are monitored and necessary action is taken to address issues, when necessary
• Manage expenses and costs and identify cost saving opportunities to support the department in achieving its financial goals and targets

• Ensure best quality work delivered by team in the execution of tasks
• Assist with implementation and maintenance of Standard Operations Procedures
• Investigate IT queries and elevate where required
• Implement team operational plans and manage that the defined delivery objectives are met through supporting, and being supported by other teams within and linked to the department / project
• Identify opportunities to improve the team's core operational internal processes and internal supply chain
• Resolve team operational conflicts
• Ensure delivery targets/objectives are met and motivate the team to operate in a mutually supportive manner to achieve successful delivery

• Plan and implement daily, weekly and/or quarterly operational changes within the team to respond to important external influences
• Ensure relevant sections of the business plan are implemented in a manner that supports operational quality and meets the defined departmental priorities
• Communicate the relevant sections of the team operational plan to facilitate buy in of the employees
• Ensure implementation of work plans in a way that maintains operational best practice and leads to continuous delivery improvement

• 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 and retain skilled and engaged employees within the team and company
• Support transformation through valuing diversity within the team and department
• Behave in alignment with the company values

• Ensure appropriate, active and informative relationships with customers and relevant stakeholders are successfully maintained
• Address customer or stakeholder complaints in alignment with the policies and procedures and ensuring customer / stakeholder buy in

• Ownership: Make critical decisions based on what's right for PHA - Owning operational decisions and knowing oneself
• Credibility: Lead with integrity and trust others as you would like to be trusted
• Living the values and being transparent
• Entrepreneurship: Take chances to continuously improve our customer's experiences -Driving operational efficiencies
• Influence: Engage with Customers and colleagues to advance the organisation's welfare -Making work happen
• Collaboration: Build work related network and share knowledge with colleagues
• Building networks
• Knowledge and application of relevant legislation
• Knowledge and application of processes and procedures

• Communication Skills
• Business Writing Skills
• Knowledge and application of clinical risk assessment
• Attention to Accuracy and Detail
• Problem Solving
• Numerical Ability
• Customer Focus
• Manage team and individual performance