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**Consultant: Disease Risk Management**:
The position reports to the Service Manager: Disease Risk Management.
**THE IDEAL CANDIDATE SHOULD HAVE**:
- 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)
**KEY RESPONSIBILITIES INCLUDE**:
- 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-
- Support the Service Manager and HOD on any projects related to risk management
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