Wellness Case Manager

4 weeks ago


Johannesburg, South Africa 3Sixty Health (Pty) Ltd Full time

3Sixty Health has a great opportunity for a suitably qualified individual to fulfil the advertised position

**3SIXTY HEALTH **and join their team.

**BACKGROUND ** 3Sixty Health is a black owned and managed, reputable and a major player in driving South African economy by investing in ‘’black excellence’’3Sixty Health is 100% black owned and black managed administrator. It is accredited by the council for medical schemes to offer both administration and managed care services, allowing for a fully integrated, beneficiary-centric approach. Our core competencies in administration include membership management, billing, claim adjudication and customer services.

It is a medical aid administrator of Sizwe Hosmed Medical Scheme.

**Wellness Case Manager**
**JOB TITLE**

**JOB GRADE**

**DIVISION ** **Disease Risk Management**

**Managed Health Care**
**DEPARTMENT**

**Responsible for participating in delivery of patient education and disease management interventions**

**JOB PURPOSE and for performing health coaching for members, across multiple lines, for health ** improvement/management programs for chronic diseases.

1
**NUMBER OF JOB HOLDERS**

**Johannesburg**
**LOCATION**

**DUTIES & RESPONSIBILITIES**
- Liaise with service providers.
- Ensure effective and efficient management of chronic
- diseases, counselling and coordinating care of patients with all chronic disease including maternity, renal dialysis, psychiatry and organ transplant,.
- Overall planning and supervising of chronic disease care management activities
- Ensure compliance with regulatory agencies and with established policies and procedures, research policies on conditions managed and provide input to the policies.
- Patient and provider education
- Interfaces with provider and other health professionals to coordinate health coaching plan for the member.
- Implements and/or coordinates coaching and/or care plans by educating members regarding clinical needs and facilitating referrals to health professionals for behavioural health needs.
- Support and implement Risk Event Assessment, and educational interventions.
- Liaise with Medical Advisor, other managers and departments including IT to ensure efficient management of chronic diseases, and automation of services.
- Psychiatry, renal dialysis, insulin pumps e.g. patients, Oxygen management, sleep apnoea management.
- Application of Disease management protocols
- Application of Scheme Rules in all aspects, and updating of protocols

**QUALIFICATIONS AND EXPERIENCE**
- Registered nurse preferably with at least 5 year case management or disease management experience, and an understanding of the managed care industry and environment.
- Strong maternity case management experience
- Excellent knowledge of all chronic diseases and their management, interest in research and development of clinical policies and protocols
- Excellent, verbal, and written communication and good interpersonal skills
- Data analysis and report writing experience related to the diseases managed.
- Understanding of integration of care, knowledge of PMBs and chronic diseases would be advantageous.
- Code 8 drivers licence essential interpersonal skills is essential

**PERSONAL ARTRIBUTES**
- Ability to work under pressure and as part of a team
- Willingness to work overtime when necessary
- Enthusiasm to accept and develop in a changing environment
- Attention to detail and accuracy
- Able to take responsibility and use own initiative

**Job Type**: Permanent

Application Question(s):

- Are you a registered Nurse with at least 5 years Case or Disease Management experience?

**Education**:

- High School (matric) (required)

**Experience**:

- Case Management or Disease Management: 5 years (required)

Application Deadline: 2024/02/20


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