Professional Nurse: Disease Risk Management Case Manager

7 days ago

Port Elizabeth, Eastern Cape, South Africa Momentum Health Full time R250 000 - R400 000 per year

Introduction

Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members.

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

  • Good understanding of the medical scheme industry is advantageous

  • Previous experience in a managed care environment would be an advantage

  • Previous experience in Primary Healthcare is advantageous with experience in HIV and TB management as per the NdoH guidelines

  • Additional experience and certificate in wound care or diabetic care would be advantageous

  • MS 365 proficiency

Duties & Responsibilities

Management of chronic diseases including but not limited to; HIV and AIDS MANAGEMENT/ Management of TB infected patients, 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 conditions/ high-cost cases

  • Liaise with providers on chronic condition management and assist in discharge planning and follow up and support.

  • Authorise and manage home based care including palliative, Stoma therapy, wound care and home nursing as per the schemes clinical policy and guidelines.

  • Work together with in hospital risk management teams to provide a holistic intervention.

  • Engage with the medical advisor and treating provider to optimally manage members in a home setting and prevent hospitalisation.

Oncology Programme

  • Register and onboarding of oncology patients.

  • Oncology treatment plan authorisations according to ICON protocols and guidelines.

  • Medical advisory referrals for out of protocol treatment requests.

  • Support members during treatment.

  • Care co-ordination for palliative or end of life care treatment plans.

Maternity Programme

  • Register and onboarding of maternity patients.

  • Educate and support during pregnancy based on risk.

  • Post-partum telephonic follow ups.

  • Authorisation of NIPT testing as per clinical protocols and scheme benefits and rules.

Competencies

  • Telephone etiquette & communication - verbal and written

  • Accountability

  • Planning and organising

  • Problem solving

  • Time management

  • Attention to detail

  • Relationship building and interpersonal understanding

  • Customer orientation and results orientation

  • Empathy

  • Teamwork and cooperation

  • Responsibility and ownership

  • Business administration skills

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