Case Manager: Disease Risk Management

1 week ago

Centurion, South Africa Health Solutions Full time

**Introduction**
- Momentum Health, an entity of the Momentum Group, delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of health capabilities.

**Disclaimer**
- As an applicant, please verify the legitimacy of this job advert on our company career page.

**Role Purpose**
- To support the optimisation and management of a cost-effective managed healthcare system, aimed at promoting the efficient use of healthcare resources and controlling the associated costs.

**Requirements**:

- A National Senior Certificate is required
- A Nursing Diploma or Degree is essential
- Minimum of 2 years clinical experience within the Healthcare industry
- The incumbent must be registered with the South African Nursing Council (SANC) as a professional nurse
- A valid driver’s licence and own insured vehicle are essential
- Good understanding of the medical aid industry is advantageous
- Previous experience in a Managed Care environment would be an advantage
- Previous experience in Primary Healthcare is advantageous
- Additional experience and certificate in HIV management will be an advantage
- MS Office proficiency

**Duties & Responsibilities**

**Management of chronic diseases including but not limited to; HIV and AIDS, TB, diabetes mellitus, hypertension, cardiac, COPD & asthma, mental illness and chronic kidney diseases**
- Register and onboarding of HIV and TB patients.
- Approval of TB and HIV medication according to HIV & TB management guidelines and protocols.
- Face to face and telephonic adherence counselling for chronic defaulters including HIV and TB.
- Care plan and medicine adherence counselling to achieve clinical outcomes per condition.
- Liaise with providers or members to optimise treatment and adherence.

**Management of high-risk / high-cost cases**
- Onsite hospital case management visits.
- Liaise with providers on chronic condition management and assist in discharge planning and follow up and support.
- Work together with in-hospital risk management teams to provide a holistic intervention.
- Home visits for special cases.

**Oncology Programme**
- Registration and onboarding of oncology patients.
- Oncology treatment plan authorisations according to protocols and guidelines.
- Medical advisory referrals for out of protocol treatment requests.
- Member support during treatment.
- Care co-ordination for palliative or end of life care treatment plans.

**Maternity Programme**
- Register and onboarding of maternity patients.
- Education and support during pregnancy based on risk.
- Post-partum telephonic follow ups.
- Authorisation of NIPT testing as per clinical protocols.

**Travel to West Wits and the North West to provide face-to-face education and support for disease management programmes to members and if needed, to meet with providers to discuss interventions as well to educate in terms of scheme protocols and benefits.**

**Competencies**
- Communication skills (verbal & written)
- Accountability
- Planning and organising
- Problem solving
- Time management
- Attention to detail
- Relationship building
- Customer focus
- Empathy
- Teamwork and cooperation
- Responsibility and ownership
- Business administration skills

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