Categories Gauteng
Salary R348k pa Negotiable
Location Centurion
Job Information

Ref 6670.

An exciting opportunity for an analytical and attention-to-detail Disease Risk Management Consultant exists in a Medical Administrators Company based in Centurion.¬† The successful candidate will utilise their Clinical, Disease and Case Management experience to build effective relationships with the company’s members telephonically.

The position reports directly to the HOD – Disease Risk Management.

The ideal candidate should have:

  • Grade 12
  • A registered Nursing qualification.
  • Disease Risk Management experience is essential.
  • A sound knowledge of the Coding Systems – ICD10 and CPT4 Principles, as well as a sound knowledge of the Medical Aid industry, Rules and Regulations, ISO and other related legislation.
  • Excellent business writing and communication skills, with exceptional telephone etiquette.
  • Strong organisational awareness to anticipate the impact of actions on other groups is essential.
  • Time management and good administration skills required.
  • Effective conflict resolution skills and the ability to work under pressure.
  • Must be a strong team player and be results driven.
  • Computer literacy (MS Office and Medical Administration system).

Key responsibilities include:

  • Contacting of members and building positive relationships to achieve positive outcomes.
  • Analysis and interpreting of reports, clinical results as well as patient history information in order to provide an action plan per patient.
  • Ensuring adherence to Scheme Rules on all authorisations and clinical updates.
  • Effective handling of Internal / External Clinical Queries.
  • Communicating¬†with members and service providers to address disease management matters.
  • Assisting with Health Risk Management monitoring and management of Hospital re-admissions.
  • Compiling and submitting detailed reports to the Scheme on costs and patient progress.
  • Educating members on their chronic conditions via email or telephonically.
  • Supporting the Service Manager and HOD on any projects related to risk management.

Preference will be given to AIC candidates.

Please email your CV to cvgauteng@etalyons.co.za with the Ref No in the subject line and if you do not hear from us within 2 weeks, please consider your application unsuccessful.

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