Job Description

Introduction

Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members.

Disclaimer

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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