Consultant:Disease Risk Management at PPS

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.