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 email@example.com with the Ref No in the subject line and if you do not hear from us within 2 weeks, please consider your application unsuccessful.