Vacancy Announcement
Position
Health Risk Management Consultant
Position Type: Temporary
Reference Number: MMH260521-5
Business Unit: Medical – International Cluster
Location: Maseru, Lesotho
About Momentum Health
Momentum Health, through the Momentum Group and its specialist brands, helps individuals, businesses, and organisations achieve their financial goals and life aspirations. The group provides healthcare, wellness, savings, investment, and employee benefits solutions, enabling clients to protect what matters most and plan for the future.
Role Purpose
To enhance and manage a cost-effective health risk management function that promotes the appropriate utilisation of healthcare benefits while containing costs associated with healthcare service providers.
Minimum Requirements
- Matric / Form 5.
- Diploma or Degree in Nursing.
- Certified Case Manager qualification.
- Registered Nurse or Enrolled Nurse.
- Three (3) to five (5) years’ clinical experience.
- Proven experience in case management as a nurse.
- Previous managed healthcare case management experience will be an added advantage.
- Knowledge of ICD-10 Coding.
- Knowledge of case management principles.
- Knowledge of healthcare management and managed healthcare.
- Knowledge of private healthcare institutions.
- Knowledge of legislation governing medical aid schemes.
Key Responsibilities
Clinical Case Management
- Coordinate hospital admissions in line with business practices and product rules.
- Authorise appropriate and cost-effective medical care and treatment.
- Educate members on healthcare benefits and product utilisation.
- Manage costs associated with inpatient and outpatient care.
- Promote quality, cost-effective healthcare interventions and outcomes.
- Communicate patient management outcomes with all relevant stakeholders.
- Monitor patient progress and ensure member satisfaction.
- Record case information accurately and prepare statistical reports.
- Ensure consistent application of benefit exclusions and clinical guidelines.
Risk Management
- Identify financial and business risks and escalate where appropriate.
- Develop and implement clinical guidelines that promote cost-effective care.
- Adhere to organisational policies, procedures, and legislative requirements.
- Take ownership of unresolved or escalated cases until resolution.
- Ensure accurate and timely completion of all case documentation.
Client Service
- Investigate and resolve client queries within agreed service levels.
- Provide accurate healthcare benefit information and professional advice.
- Build and maintain positive relationships with members, healthcare providers, and stakeholders.
- Deliver services in accordance with agreed Service Level Agreements (SLAs).
- Recommend improvements that enhance client service and fair treatment.
- Participate in initiatives that strengthen customer relationships and service delivery.
Stakeholder Management
- Liaise with healthcare providers to improve the cost-efficiency of healthcare services.
- Work collaboratively with colleagues, clients, and stakeholders.
- Participate positively in organisational change initiatives.
Professional Development
- Continuously develop professional, industry, and legislative knowledge.
- Maintain up-to-date technical and product knowledge.
- Contribute innovative ideas that improve business processes.
- Take ownership of personal career development.
- Manage time effectively to maximise productivity.
Financial Responsibilities
- Identify opportunities to improve operational efficiency and cost-effectiveness.
- Manage company resources responsibly.
- Contribute to organisational risk identification processes.
- Prepare, interpret, and present healthcare and financial information to support informed decision-making.
Competencies
- Examining Information.
- Articulating Information.
- Following Procedures.
- Interacting with People.
- Understanding People.
- Managing Tasks.
- Establishing Rapport.
- Valuing Individuals.
Closing Date
27 July 2026