Health Risk Consultant at METROPOLITAN LIFE BOTSWANA

Closing Date	2024/11/08
Reference Number	MMH241024-2
Job Title	Health Risk Consultant
Position Type	Permanent
Role Family	Medical
Cluster	International
Remote Opportunity	None of the time
Location – Country	Botswana
Location – Town / City	Gaborone
Introduction	Metropolitan Health Botswana is looking for an innovative and energetic individual to fill the position of Health Risk Consultant.
Disclaimer	As an applicant, please verify the legitimacy of this job advert on our company career page.
Role Purpose	Reporting to the Health Risk Management Specialist, the incumbent will be responsible for ensuring delivery of appropriate, cost effective primary, secondary and tertiary health care through provision of support and authorisation of managed care health services to contribute to cost effective delivery of the scheme benefits to members.
Requirements	A Degree in general nursing or healthcare related field Registration with the relevant professional body 3-5 years’ post qualification experience A postgraduate qualification in health risk management, healthcare management, or a related field is an advantage Experience in health risk management, healthcare consulting, or a related role within the medical aid or insurance industry
Duties & Responsibilities	Authorisation of hospitalisations/admissions to appropriate facilities, and use of services in line with clinical needs or requirements of members. Authorisation of non–hospitalisation services i.e. chronic disease and HIV program enrolments, specialized dentistry, oncology, dialysis, medical and surgical appliances in line with disease management protocols. Confirmation of member eligibility to ensure that services are rendered according to scheme rules, approved protocols and in compliance with the appropriate levels of care. Analysing health data and claims to identify trends, potential risks, and areas of concern within the member population. Monitor and evaluate the effectiveness of health management programs, making adjustments as necessary to improve outcomes. Educate members on the importance of preventive care, healthy lifestyle choices, and adherence to treatment plans. Work with providers to ensure that care is evidence-based, cost-effective, and aligned with best practices. Ensure that all health risk management activities comply with relevant regulations, industry standards, and scheme policies. Receive and resolve clients’ enquiries and queries relating to pre-authorisations. Provide statistics and reports for the managed health care function to management. Oversee relationship building with key stakeholders as required. Ensure client satisfaction through active management of client satisfaction index.
Competencies	Excellent attention to detail and accuracy Strong analytical and problem-solving skills Excellent communication and interpersonal skills Proficiency in Microsoft Office Suite Strong organizational skills Ability to work independently and as part of a team Strong customer service ethos Results driven Compliance with procedures and deadlines Uphold the highest standards of integrity and ethics in handling sensitive member information and making claims decisions