Case Management Lead

2 weeks ago

Sandton, South Africa Coloplast Full time

**Location**:
Sandton, ZA

**Job Family**: Consumer
**Country/Region**: South Africa
Case Management Lead
- Coloplast South Africa

Case Management Lead
- making sure our Consumers get the best possible care in SA

If you believe that when an individual with an intimate health care need reaches the optimum level of wellness and functional capability, then everyone benefits; the role of Case Management Lead at Coloplast may be the perfect fit for you

Coloplast is a leading MedTech company that develops products and services that make life easier for people with intimate healthcare needs. We have embarked on a -focused journey to get even closer to the s of our products, hence the need to make sure that we provide the best support possible when it comes to Case Management and funding of these products through various Medical Aid Schemes.

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.

When joining Coloplast you will enter a truly global company that offers great challenges, opportunities and rewards. Reporting to the Head of Direct Operations for South Africa, you will be situated in our Sandton based office, together with the local HQ team.

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;
Excellent numerical skills and the ability to construct fact-based recommendations and business cases

Pursuing an ambitious growth agenda, Coloplast develops and markets products and services that make life easier for people

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