Job Description

DISEASE MANAGERS - WESTVILLEIntroductionWe currently require several well experienced Disease Managers to educate and support our members with the aim of empowering them to manage their disease better thereby improving their health outcomes and limiting healthcare costs whilst maintaining quality of care.Duties & Responsibilities Accountabilities: Client service delivery and qualityFollow procedures and cooperate with peers and leader for best possible service delivery Compliance and Risk ManagementDefined legal, statutory and regulatory compliance is maintained at the required standardsOperational risk and governance structures, measures and frameworks are complied with and necessary action is taken to address issues, when necessary Financial ManagementContribute to cost savings within the department to assist with financial goals and targets Continuous improvement Operation ModelMeet delivery objectives through working with other team members within and linked to thedepartment / projectResolve operational performance variations and problems and escalate unresolved issuesto higher levels Ensure delivery targets/objectives are met and operate in a supportive manner to achievesuccessful deliveryProvide appropriate and impactful telephonic and written counselling, education andsupport to allocated clients with high risk or long term illnesses, thereby reducing hospitaladmissions and risk factorsComplete required administration and case information on assigned cases to standard andwithin deadlineHandle and resolve medical and claim related fund queriesIdentify high risk patients and clients and, when appropriate, refer to alternativeprofessionals for additional support (such as social workers) Drive customer-centricityMaintain a high level of impact on other departments to support improved delivery - Continually increase understanding of client and stakeholder needs, satisfaction and service delivery Knowledge managementEnsure that adequate knowledge regarding specialisation is shared as required and maintained within a research library - Provide advice and / or training as requiredMaintain, develop and implement specialist knowledge within the day-to-day operations of the organisation Maintain expertise levelBe a member of related professional bodiesEnsure CPD (continual professional development) or similar accreditation requirements are met annually to ensure maintained specialist accreditation Network key relationshipsEngage with and provide support to the established network of internal and external expert resources and partnersOperational Implementation of StrategyKeep up to date with operational changes implemented in response to important external influencesDeliver in a manner that supports and meets operational quality standards and meets the defined departmental prioritiesPerform according to defined operational best practice and identify and implement opportunities for continuous delivery improvement Operational LeadershipDeliver personal performance within Human Capital frameworks and policies to ensure delivery to agreed standards and objectivesEngage in development, coaching and mentoringSupport transformation through valuing diversityStakeholder ManagementEnsure appropriate, active and informative relationships with customers and relevant stakeholders are successfully achievedAddress customer or stakeholder complaints in alignment with the policies and procedures and ensuring customer / stakeholder buy-i KEY PERFORMANCE AREAS Logical exploration of problems with innovative solutions.Able to work with, and encourage participation in, team efforts.Able to handle concurrent tasks.Committed to good business ordinance, maintaining an effective internal control environment.Able to manipulate data to produce management information.Committed to responsible resource management Desired Experience & QualificationExperience: 8 years relevant managed care, health risk and clinical customer service within Medical Scheme Administration Industry or similar. Understanding of disease processes and the relevant disease markersAble to communicate effectively with and favourably influence the actions of others not under their control.Negotiation and Telephone SkillsSolid working experience with :HIV, Oncology, Diabetes, Asthma, Renal Failure and Cardiac diseases and holistic management of these conditionsMotivational counselling and health education techniques Qualifications: Registered Nurse with 3 or 4 year Medical diploma/degree (MANDATORY REQUIREMENT) Package & RemunerationMARKET RELATED

JTJ Group