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To manage clinical risk of patients through the authorisation of clinically appropriate treatment and outbound interventions.
What You’re Going To Do
- Liaising with patients, providers and Disease Management companies
- Answering all queries related to Oncology, Renal dialysis and Organ Transplant , HIV and Mental Health disease programmes and 26 Chronic Disease Lists
- Following up decisions with Providers and/or 3rd parties
- Monitoring the progress of patients on all disease management programs
- Maintaining relationships with 3rd parties
- Assisting with early detection programmes and advocating available preventative health benefits to better manage risk
- Facilitating reports to 3rd parties and the schemes
- Initiating outbound contact with patients and providers where appropriate
- Identifying and developing Clinical Guidelines and policies
- Authorising appropriate and cost effective medical care and treatment
- Participating in the identification of clinical guidelines
- Researching, designing and developing material relevant to promoting awareness of health promotions e.g. Focus pages
- Identifying all compliance risks
- Educating and guiding all members regarding health care and their benefits
- Supporting budget control and cost containment of health management programmes
- Assisting with registration on various programmes to ensure quality of life for patients with life threatening diseases
- Dealing promptly with client requests in a competent, efficient and professional manner
- Liaising with specialists to gain their insight into assessing risks
- Communicating with providers to improve the cost efficiencies of healthcare delivery
What You’ll Need
- Matric
- Nursing Diploma or Degree essential
- Registered Nurse (Registered with SANC essential)
- Minimum of 4 years clinical experience essential
- Experience in renal dialysis, organ transplant or oncology is essential
- Experience in managed health care would be advantageous
- Experience in the management of chronic diseases would be advantageous
What Competencies You’ll Require
- Accountability
- Planning
- Organization and Attention to Detail
- Customer orientation
- Empathy
- People skills
- Teamwork and Cooperation
- Business Administration
- Results Orientation
Additional Information
- Shortlisted candidates will be subject to the following statutory checks:
- References
- Qualifications
- Credit
- Criminal