The aim of this position is to manage quality and cost of clinical and medical care by liaising with members and providers.
Build strong relationships through providing specialist know-how and leadership to others, expressing positive expectations.
Prioritise work in accordance with required intensity of patient management.
Daily planning and organisation in accordance with allocated member.
Accountability for daily work load and required interventions.
Interaction with member, GP and Specialist and other providers including homebased and convalescent nurses.
Manage quality and cost of clinical and medical care by liaising with members and providers and managethe reduction of recurring costly events and medicine spend.
Work with individual consumers (beneficiaries and providers) of the scheme to achieve better health outcomes while helping beneficiaries to understand their disease(s) or health status.
Reduce the downstream clinical and financial risk associated with the beneficiary.
Co-ordinate the required interactions between the various providers and hospitals.
Keep detailed records of patient interaction and follow-ups done by updating system records.
Ensure the effective, accurate and timeous completion of relevant documentation accompanying transactions.
Continued Medical Education task.
Manage cost of an in or out-patient episode by implementing appropriate policies and guidelines.
Arrange post hospital care where necessary.
Authorise appropriate and cost effective medical care and treatment.
Ensure the consistent and correct application of exclusions.
Adhere to policies and procedures and take corrective action where necessary.
Adhere to organisational best practice and legislative requirements.
Ensure accurate application of acute case management protocols.
Continuously monitor turnaround times and quality standards and resolve issues speedily to enhance client service delivery.
Contribute to the development of area specific budgets to minimise expenditure,in alignment with operational plans.
Nursing Diploma or Degree
Enrolled Nurse or Registered nurse isessential
Training as Primary Care Nurse Practitioner will be an advantage
One year case management experience in a managed caree nvironment
Three years clinical practice in the discipline
Experience in both hospital case management and/ or disease management will be an advantage
Experience as a home based case nurse will be an advantage
Experience in community Health Centre base nursing care will be an advantage
Experience as a registered nurse or ENA will be an advantage
Possess the applicable registration to the respective professional bodies as it is required by the Medical Schemes Act (Regulation 15D (1)(d)
High standards of personal integrity, honesty and respect for confidentiality and feedback to clients.
Be sensitive to individual and cultural differences and demonstrates humility and an openness to engage people from diverse backgrounds and cultures to the mutual benefit of all parties concerned.
Manages self and relationships with others effectively, deals with ambiguity, uncertainty and pressure, and provides perspective in difficult situations.
Understands how the business operates, what the key issues and risks are that drives business success
Actively leads change, does what is right fo rthe business and drives continuous improvement through innovation.
Presence and flexibility in the wellness coaching process.
Prepared to take accountability for the relationship with the beneficiary.
Sensitive and open-minded.
Ability to express the patient roadmap clearly and succinctly.
Analytical and able to identify and interact on relevant and important questions and aspects as are important to the beneficiary.
High levels of responsibility and discernment about own role in the patient management cascade.
Good level of clinical competencies.
Synthesizing and analytical skilled relevant to the clinical requirements of interaction with beneficiaries that have higher levels of complexity of clinical needs clinical needs
Shortlisted candidates will be subjected to the following statutory checks:
Kindly note that if you havent received feedback within in 3 weeks of submitting your application, consider it as unsuccessful
Pharmaceutical And Medical/Healthcare
Cost To Company
Western Cape – Northern Suburbs (Cape)