Case Management Lead at Coloplast

As Case Management Lead, you would form an integral part of the journey by facilitating the reimbursement process and using the available resources to promote Consumer quality of care, and the best possible funding outcomes.

Your key responsibilities

Coloplast Consumer advocacy

• Work cross-functionally to ensure smooth end-to-end authorization for Ostomy and Incontinence Consumers that delivers an optimal  experience;
• Create and maintain a clear set of guidelines that educates Consumers on their condition, their funding options and their Medical Scheme benefit limit and rules.
• Help Consumers navigate our local health reimbursement system and own their relationship with the Medical Schemes by connecting them with the correct departments within medical schemes.
• Provide guidance on early case strategy and the appropriate pathway for future management i.e., settlement or investigation.

Relationship building with internal and external stakeholders

• Own and create the relationship with Medical Aid Schemes in South Africa together with Market Access to ensure close collaboration for improved patient outcomes.
• Acting as a technical expert for the team, by reviewing and dealing with complex, challenging and sensitive case management issues when it comes to Consumers’ needs.

People Leadership

• Live our leadership principles and proactively manage the team of Case Management Specialists and their KPIs
• Coaching and training of the team and ensuring new processes are implemented effectively

Reporting and tracking

• Lead the case management processes by using a continuous improvement mindset (identify need for change, plan, implement and test).
• Implement Case Management controls for tracking and feedback to our Consumers and our internal team.
• Agree to clear KPI’s, and drive performance management against those KPIs.

Forward thinking and innovation

• Monitoring and gaining an understanding of the evolution of medical aid plans and collaborating with key stakeholders in the financial management of treatments;
• Mitigation of risks related to health spend.
• Review Treatment plans on a case by case basis, within the bounds of protocols and guidelines;

Education and Experience Criteria

• High school diploma or equivalent required;
• Minimum education of Bachelor’s Degree;
• Minimum 2 years’ experience in a funding or managed care related environment. 
• Relevant experience in case management with a key understanding of the funder landscape within South Africa is crucial.
• 2 years team lead experience is advantageous

Knowledge, skills and abilities

• We are looking for an experienced, commercially minded and operationally strong case management lead with a proven track record of implementing and streamlining projects and making sure they have high impact for the business and the care of our Consumers.
• Thorough knowledge of case management principles, healthcare management and ICD coding knowledge;
• A comprehensive understanding of the Medical Schemes Act and regulations;
• Set knowledge and expertise when it comes to PMB (Prescribed Minimum Benefit) conditions and PMB level of Care;
• Strong business acumen and commercial understanding;
• Strong written and verbal communication skills; reporting skills;
• A deep passion for customer service and an understanding of customer behaviour;
• Ability to convey medical terms and treatment plans so they are understood by Coloplast Consumers;
• Excellent organisational and time management skills;
• Astute problem-solving skills with the ability to multi-task;
• Compassionate and empathetic demeanour for Consumers with the ability to work both independently and in a group/team environment;
• Effective and the skilled use of Microsoft Office Products (PowerPoint, Excel, Word, Teams and Outlook) skills, plus the ability to use a variety of other word-processing, spreadsheet, database, e-mail and CRM software (preferably experience in SalesForce);
• Excellent numerical skills and the ability to construct fact-based recommendations and business cases