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Medical Aid Case Worker Gauteng

1 week ago

Johannesburg, Gauteng, South Africa Fusion Recruitment Full time

Disease Management Specialist

About the Role

This role involves working closely with healthcare professionals to manage disease programs, maintain risk profiles, and improve patient outcomes.

The ideal candidate will have excellent knowledge of Chronic Disease treatments and procedures, as well as experience in disease management.

Key Responsibilities
  • Maintain risk profile of members enrolled on Disease Management Programmes
  • Ensuring continuous improvement and process improvement
  • Production of educational material and dissemination to patients
  • Retrospective review of related claims
  • Developing and maintaining clinical protocols including new drug reviews
  • Liaising with pharmaceutical companies
  • Compilation of monthly reports detailing programme progress and areas of cost containment
  • Keep abreast of benefit changes

The successful candidate will be responsible for:

  • Member retention and customer services
  • Working with other healthcare personnel within the organisation
  • Develop and deliver educational presentations to employer groups
Requirements

To be considered for this role, you must have:

  • Excellent knowledge of Chronic Disease treatments and procedures
  • Registration with the South African Nursing Council
  • Minimum Experience: Registered Nurse with HIV experience
Benefits

The successful candidate will receive a competitive salary package including pension and provident fund, medical aid, funeral cover and trauma and disability insurance.