Drm Case Manager Sabmas

9 hours ago

Gauteng, South Africa 3SixtyHealth (Pty) Ltd Full time

**POSITIONS ** Disease Risk Case Manager

**DIVISION ** Operations

**DEPARTMENT ** Managed Health Care

Proper risk management and integration of preventative healthcare services with the objective of promoting self-management and better control of chronic conditions through a holistic, individualized
**JOB PURPOSE ** approach which supports improvements in health status and appropriate utilization of medical services supported by evidence based medical guidelines and the most influential behavioural techniques.

**LOCATION ** Head Office, 7 West Street, Houghton, Johannesburg

**DUTIES AND RESPONSIBILITIES**
- Utilizes wellness management strategies, that includes and not limited to national wellness campaigns
- Giving health talks or presentations and invite members to enrol and participate in Disease Management Programs.
- Registration of members on Wellness management
- program according to Scheme rules and managed care policy including patient and family education
- Establishes supportive relationship with enrolled members and assumes ongoing primary measures to promote preventative care
- Provides counselling, telephonic assessment and health coaching to beneficiaries enrolled with chronic conditions not limited to diabetes, respiratory conditions, cardiac conditions, mental disorder, hypertension, HIV/AIDS etc
- Advice individuals on managing all components of their condition including adherence to medications, understanding and managing risk factors, maintaining up to date screenings, monitoring tests and more
- Prioritize the planning, implementation and evaluation of chronic disease management and education for health plan members Assist with the Disease Management process along the continuum of care and functions as a community resource for beneficiaries, providers etc
- Works in partnership with disease management and case management staff to develop, implement and maintain health and disease management initiatives and programs
- Develops collaborative relationships with other health care partners to facilitate and support quality chronic disease education and teaching services
- Develops strategies to address compliance issues for members at risk; including member support and outreach
- Participates in quality improvement activities involving chronic disease and health management programs
- Works with the member and their treatment team to identify and establish attainable goals that positively impact clinical, financial, and quality of life outcomes for member
- Establishes supportive relationship with enrolled members and assumes ongoing primary responsibility
- Documents all pertinent information pertaining to health strategies used and beneficiary progress made
- Registration of members on Wellness management program according to Scheme rules and managed care policy including patient and family education
- Contributes to the team effort, maintains customer confidence, and identifies potential quality issues by attending department meetings; giving and receiving feedback.
- Accomplishing related results as needed; keeping information confidential; communicating quality of care issues
- Fostering relationships with staff at assigned hospitals to improve coordination of care at appropriate levels
- Maintain an excellent punctuality record.
- Punctuality include being on time as stipulated in HR contract
- It excludes working outside approved working hours for own backlog that has not been pre-authorized.
- Authorized time outside working hrs is at the discretion of departmental manager and counts as either time back or remuneration
- Maintain an excellent attendance record.
- Attendance includes approved annual, study and family responsibility leave.
- It excludes sick and unpaid leave.

**QUALIFICATIONS**
- Registered Nurse (with SANC) with at least 3 years Private Hospital experience
- A sound knowledge of hospital claims and charges (NHRPL)
- Sound knowledge of the Medical Schemes Act
- Sound knowledge of Prescribed Minimum Benefits.
- Good computer skills (MS Word, MS excel, PowerPoint)
- Hi Care / ICU / theatre experience advantageous
- Case management experience at least 2 yrs.
- Code 8 drivers license an advantage ATIONS AND EXPERIENCE

**PREFERRED MINIMUM EXPERIENCE**
- Registered Nurse (with SANC) with at least minimum three (3) years’ experience in a health care environment; preferably managing the care of chronic diseases
- Minimum two-three (2-3) year experience in case management or equivalent
- Hi Care / ICU / theatre experience advantageous
- Sound knowledge of the Medical Schemes Act
- Sound knowledge of Prescribed Minimum Benefits
- Code 8 drivers license an advantage
- **PERSONAL ATTRIBUTES**:

- Ability to work under pressure, and meet deadlines
- Have an eye for detail and must be accuracy
- Ability to work as part of a team
- Goal orientated
- Responsible and be able to use own initiative
- Ability to communicate at all levels

**Job Type**: Permanent

Ability to commut

  • Case Manager

    4 days ago

    Gauteng, South Africa Careforce Recruitment Full time

    Our client, a managed care organisation based in Pretoria is looking for a Case Manager. This is an equal opportunity organization with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries. Position: Case Manager (Member Management) Reporting to: Senior Specialist Clinical Management Location: On-site...

  • Snr Manager: Case Management

    1 week ago

    Ekurhuleni, Gauteng, South Africa City of Ekurhuleni Full time

    Location- City of Ekurhuleni- Remuneration- R 801,780 to R 1,099,896 - Basic salary per annum (plus benefits)- Assignment Type- Permanent**Minimum Requirements**: - Matric - LLB / B Degree majoring in Labour Law - 8 years relevant managerial experience in labour law & local government or similar environment - Knowledge of all applicable South African...

  • Medical Case Manager

    1 week ago

    Gauteng, South Africa Africa and Worldwide Medical Assistance Company (PTY) Ltd Full time

    Duties may however include but not be limited to assistance relating to: - Emergency Medical Services - GP Authorizations - Hospital Pre-Authorization and claims - International Travel Assistance - Trauma Counselling - Medical Advice - Invoice Management - Basic Administration Ability to commute/relocate: - Gauteng, Gauteng: Reliably commute or planning...

  • Head: Enterprise Project Management

    1 week ago

    Gauteng, South Africa MGiBA Technologies Full time

    To manage and improve the EPMO strategy, frameworks and policies aligned to industry standards, regulatory requirements, and risk management that is fit for company requirements. To manage the enterprise-wide portfolio of the EMPO which includes a designated team of Project Managers, Programme Managers, Administrators and Analysts (Permanent & Contracted)...

  • Project Manager

    3 days ago

    Gauteng, South Africa Armstrong Appointments Full time

    **Main job function** Manage renewable projects from the initial business development phase through commercial operation by leading and executing the following activities from conceptual and preliminary design, all the way to project completion and handover to operations. Qualifications: - Bachelor’s Degree in Engineering - Mechanical or Electrical...

  • Warehouse Manager

    3 days ago

    Gauteng, South Africa ASIE Personnel Full time

    Our client a leading food manufacturer is looking for a Warehouse Manager to join their team at their Johannesburg plant. To manage and control the warehouse in all aspects of the operation to ensure that the business processes are conducted efficiently on a daily basis. Should be proficient in planning, warehouse control, housekeeping and maintenance,...

  • Office 365 System Administrator

    1 week ago

    Gauteng, South Africa Pink Elephant Full time

    **MAIN RESPONSIBILITIES**: - Responsible for monitoring all operational team queues in client ITSM tools. - Responsible for working cases assigned to all operational team queues in client ITSM tools. - Responsible for monitoring and analysing Office365 environments and services for clients to ensure the highest standard of customer service in accordance...

  • Distribution Sales Manager

    2 days ago

    Gauteng, South Africa Ingersoll Rand Full time

    Location: Gauteng, GT, ZA- Req ID: 7231**Job Summary**:As a Distribution Sales Manager you would be responsible for **ARO**, Sub-Saharan Africa. Your job would include reaching out and travelling directly to our customers. Besides time on your travels in this area, you will be able to spend your time working in a hybrid way - from your own home as well as...

  • Academic and Student Experience Manager

    10 hours ago

    Gauteng, South Africa Eduvos Full time

    **Job Advert Summary**: Eduvos is looking to hire the services on an **Academic and Student Experience Manager for our Online** campus on a full time basis. Position Type: - Permanent The Position: - To ensure and a positive student experience on a campus outside the classroom to ensure that a student is successful in his/her learning and teaching...

  • Junior Product Manager

    9 hours ago

    Gauteng, South Africa Telesure Careers Full time

    Is responsible for the product performance reporting and analysis, generating insights from reports, preparation of product reporting packs for various stakeholders and competitor analysis on product propositions. **Job Functions** Data Analysis,Data Management **Industries** Insurance **Specification** Product Insights and Reporting Contribute to the...

  • Rn Travel Nurse

    3 days ago

    Gauteng, South Africa Unique Health Full time

    _**REGISTERED NURSE ( TRAVEL NURSE - IN HOSPITAL VISITS / DISEASE RISK MANAGEMENT AND IN SERVICE TRAINING - GAUTENG **_ Must be Registered with SANC No criminal record Hospital case management experience a must Must be able to do wound care / Iv therapy / drawing of blood Must be able to do in-service training with junior staff. Excellent communication...

  • Project Managers

    4 days ago

    Gauteng, South Africa Letsema Full time

    Independent Contractors / Freelancers - 3 month to 12 month contracts Programme/Project Manager Letsema would like to engage exceptional, high performing Project Managers for diverse Fixed Term Contracting opportunities. Successful applicants will be assigned to current or future, high impact projects supporting our clients' strategic objectives. At...

  • Junior Actuarial Manager

    2 days ago

    Gauteng, South Africa Telesure Careers Full time

    Manage a team of Actuarial Analysts that support the Business goals as set out by senior management by effectively modelling and monitoring business Actuarial solutions. This team will care take all TIH short term brands, products and distribution channels. **Job Functions** Analysis,Analytics **Industries** Insurance **Specification** Business...

  • Corporate Finance Director

    1 day ago

    Gauteng, South Africa Debbie Joubert Recruitment Full time

    Our client within the Fintech industry is looking for a detail-oriëntated Head of Finance. This role will be leading the reporting function for short-term insurance, while collaborating with stakeholders to deliver quality insights on market dynamics, business drivers and financial performance. The successful candidate will also play an essential role of...

  • Creditors Clerk

    2 days ago

    Gauteng, South Africa Natebo Consulting Full time

    **PRIMARY PURPOSE** To accurately capture and reconcile invoices in the accounting system in order to effect payment accurately and timeously to Creditors. **Detailed Responsibilities** - Ensure invoices are properly authorized in accordance with levels of authority and allocate to the correct Supplier and General Ledger accounts on a daily basis. - Refer...

  • Onboarding Specialist

    1 day ago

    Gauteng, South Africa Jobs 4 All Full time

    **Customer Onboarding Specialist** **Location: Remote Department** **Operations Package: Market Related** **Reports to: COO** Customer Onboarding Specialist An onboarding specialist is the one who makes sure the customer has the first moment of success with the the platform. They must ensure that customers’ expectations have been met and that they feel...

  • HR Consultant: Learning and Development

    2 days ago

    Gauteng, South Africa The Foschini Group Full time

    **Key responsibilities**: - Program design and development (this includes audio and visual aids) - Delivery of training interventions - One on one learner interactions - Ensure training delivery aligned to business objectives - Assessment, Moderation and Evaluation - Administration (facilities, invites and attendance registers) - Reporting and documentation...

  • Security Incident Response Analyst

    1 week ago

    Gauteng, South Africa Pink Elephant Full time

    **MAIN RESPONSIBILITIES**: - Handling of Incidents through ticketing systems and follow through completion and/or escalation in accordance with established procedures. - Work in correlation with SLAs as applicable for day-to-day Operations - Troubleshooting security incidents, reported by end-users, or discovered by proactive health checks - Monitor...

  • Senior Systems Analyst

    1 week ago

    Gauteng, South Africa Hi-Tech Recruitment Full time

    **Gauteng**, Gauteng** **R 700 000 - R 800000 Monthly Cost To Company (Market related, Negotiable)** **Are you looking for a Key player role, then don’t look any further!** *** **We are looking for a Senior Systems Analyst to be a key player on Group and Divisional Applications support team, from problem detection to overseeing and providing support...

  • Service Desk Analyst

    9 hours ago

    City of Johannesburg, Gauteng, South Africa Qunu Staffing Full time

    Technical Customer Support - Level 2 (French First Language) second language (any) **Position Profile**: Technical Customer Support Rep Level 2 provides remote technical support to our clients. The Level 2 position plays a direct role in the overall service level of our company. This requires a strong technical skillset, great customer service skills, and...