Celiwe Mngomezulu

• Enhanced member experience through local support and case coordination, addressing individual needs and concerns.
• Acts as an escalation point for healthcare access challenges.
• Facilitates communication between clients, members, providers, and internal Cigna teams.
• Coordinate and follow up on individual member cases and access-to-care issues.
• Ensures effective delivery of healthcare services and resolution of operational issues
• Builds relationships with HR teams, medical units, and key stakeholders.
• Provided insights into local healthcare markets and provider environments to inform strategic decisions.
• Provided daily assistance to client offices and members to ensure smooth operations.
• Supported health promotion initiatives and staff education activities after client approval. P

• Act as the primary liaison between providers and Cigna in South Africa, Eswatini, Botswana, Namibia, Zimbabwe.
• Acted as the primary point of contact for provider inquiries on behalf of the provider team, developing and maintaining strong relationships with network healthcare providers.
• Collaborate with Network and Provider teams for contracting, credentialing, provider operations, claims, network management In South Africa.
• Conduct regular provider meetings and service reviews on behalf and also with the Network team and Provider relations team.
• Managed provider and staff enquiries, delivering comprehensive information on services to improve satisfaction within South African context
• Supported providers with inquiries and operational challenges to ensure efficient service delivery
• Conducted follow-ups with clients to resolve access to care concerns

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• Coordinate care between members, physicians, hospitals, specialists, and families.
• Support members with complex conditions such as cancer, transplants, ICU admissions, high-risk pregnancies, and prolonged hospitalizations.
• Assess members' medical conditions, treatment plans, and healthcare needs.
• Monitored treatment progress and assisted with discharge planning to ensure seamless post-hospital care.
• Identify gaps in care and barriers to recovery to improve member outcomes.
• Facilitated access to appropriate healthcare providers and services, enhancing member support.
• Coordinate clinical programs such as Case Management, Chronic Condition Management, and Decision Support Programs.
• Provide education on diagnoses, treatment options, medications, and expected outcomes.
• Advocate for members while balancing clinical and business requirements.
• Maintain regular communication with members and healthcare providers throughout the care journey
• Conducted hospital visits to assess and support members with complex medical conditions. to members with complex medical conditionss and doing hotel visits for medevac members who are receiving long-term treatment or treated for complex condition as outpatient

• Manage medium to complex medical cases from initial notification through resolution.
• Triage medical situations and determine appropriate levels of care.
• Coordinate emergency medical evacuations and repatriations.
• Liaised with hospitals, physicians, clinics, embassies, insurers, and reported back to employers on medical status and suitability for return to work.
• Monitored hospitalized patients and communicated regularly with treating physicians to ensure continuity of care.
• Conducted virtual triage for sick airline crew members, delivering first aid treatment at hotels or coordinating referrals to local medical facilities for further care.
• Supported triage processes by evaluating airline passengers at airport gates, determining their fitness to board flights and travel.
• Received and responded to emails and calls from maritime ship captains regarding medical assessments for crew members, coordinating immediate treatment onboard or arranging necessary medical care upon reaching the next port.
• Assess medical cases received through Johannesburg assistance Centre.

• Coordinated morbidity and mortality conferences to enhance patient care and clinical outcomes.
• Monitored staff performance and developed improvement plans.
• Organised staff rosters to maintain optimal coverage during peak times while minimising excess staffing.
• Managed organisational resources to align with budgetary guidelines, ensuring quality and timely administrative and operational support.
• Collaborated with other managers to plan and direct organisational tasks.
• Worked with leadership to develop and implement action plans to protect company assets and profitability.
• Managed customer service operations, resolving issues promptly to maintain high satisfaction levels.
• Dealt with customer complaints calmly and effectively, resolving issues with timely solutions.

• Led and coordinated the delivery of safe, effective, evidence-based care for critically ill patients.
• Supervised nursing staff and managed operations in critical care unit to ensure high standards of patient care
• Managed deteriorating patients and emergency situations with medical doctors
• Optimised staffing and workload distribution based on patient acuity to enhance care delivery
• Led audits and quality improvement initiatives to elevate care standards in critical care unit
• Maintained a safe, clean, and comfortable environment for patients, adhering to infection-control policies.
• Provided guidance and support to newly qualified nurses and students to enhance their clinical skills and confidence..
• Delivered manual handling training sessions for staff in the critical care unit to ensure compliance with safety protocols..
• Contributed to policy development and service improvements.

• Managed emergency situations with professionalism, administering immediate care and coordinating with medical teams to ensure patient safety.
• Recognised patient deterioration to ensure timely intervention and improve overall care quality.
• Monitored, recorded, and reported changes in patient symptoms to enhance care delivery.
• Maintained a safe, clean, and comfortable environment for patients, adhering to infection-control policies.
• Documented clinical risks to improve safety protocols and mitigate future incidents.
• Maintain accurate clinical documentation and records
• Participate in handovers, ward rounds, and multidisciplinary meetings
• Supported, supervised, and mentored healthcare assistants, students, and junior staff to foster skill development and improve patient care.
• Contribute to staff training and development