Job Advert Summary
An exciting opportunity for an analytical and attention-to-detail Disease Risk Management Consultant exists. The successful candidate will utilise their Clinical, Disease & Case Management experience to build effective relationships with our members telephonically.
Applications are invited for the above-mentioned position, to be filled as soon as possible.
Minimum Requirements
Qualifications & Experience
- Grade 12
- A Registered Nursing qualification
- Disease Risk Management is essential
- Sound knowledge of the Coding Systems: ICD10 & CPT4 Principles and sound knowledge of the Medical Aid Industry, Rules & Regulations, ISO and other related legislation
- Excellent business writing & communication skills with exceptional telephone etiquette
- Must have strong organisational awareness to anticipate the impact of actions on other groups.
- Time Management & good administration skills
- Effective conflict resolution skills and the ability to work under pressure
- Must be a strong team player and results driven
- Computer literacy (MS Office and Medical Administration system)
Duties and Responsibilities
- Contacting of members and building of positive relationships with the members to achieve positive outcomes.
- Analyse and interpret reports, clinical results, and patient history information to provide an action plan per patient.
- Ensure adherence to Scheme Rules on all authorisations and clinical updates
- Effective handling of Internal/External Clinical Queries Communicate with members and service providers to address disease management matters
- Assist with Health Risk Management Monitoring & Management of hospital re-admissions
- Compile & submit detailed reports to the Scheme on costs and patient’s progress
- Educate members on their chronic conditions via email or telephonically.
- Support the Service Manager and HOD on any projects related to risk management.
Preference will be given to Employment Equity candidates
You acknowledge that any information supplied to PPS is provided voluntarily and therefore constitutes unconditional, specific, and voluntary consent to the processing of such information by PPS. Your personal information will be processed for facilitating your application for employment with PPS as well as any statutory or regulatory compliance with which PPS must comply (where applicable) and for the legitimate interests of PPS and yourself, both during the recruitment process and thereafter. You may instruct PPS by written notice to cease the processing of your personal information at any time and, subject to the requirements of applicable South African law, request that PPS delete and/or de-identify such personal information.
As a responsible employer, PPS encourages you to vaccinate and take the recommended vaccine boosters. The Company reserves the right to amend this stance, as and when required.
