Role Purpose

• To manage clinical risk of patients through the authorisation of clinically appropriate treatment and outbound interventions.

Requirements

• Matric
• Nursing Diploma or Degree essential
• Minimum of 4 years clinical experience (including 2 years Oncology experience) essential
• Registered with SANC essential
• Experience in managed health care would be advantageous

Duties & Responsibilities

• Liaising with patients, providers and Disease Management companies
• Answering and assisting with all queries related to disease management programmes (Oncology and other chronic conditions)
• Following up on decisions with Providers and/or 3rd parties
• Maintaining relationships with 3rd parties
• Monitoring the progress of patience on disease management programmes.
• Assisting with early detection programmes and advocating available preventative health benefits to better manage risk
• Facilitating reports to the scheme
• Initiating outbound contact with patients and providers where appropriate
• Educating and guiding all members regarding health care and their benefits
• Authorizing appropriate and cost-effective medical care and treatment
• Applying set Clinical Guidelines and policies
• Possible identification of clinical guidelines.
• Identifying all compliance risks.
• 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 insight into assessing risks.

Competencies

• Accountability
• Planning
• Organization and Attention to Detail
• Customer Orientation
• Empathy
• People skills
• Teamwork and Cooperation
• Business Administration
• Results Orientation