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Health Programme Coordinator-Middelburg, Mpumalanga

1 month ago

Pretoria, South Africa MNA Recruitment Full time

A leading medical aid scheme company is seeking a Health-Programme-Coordinator.

Requirements

Key Responsibilities:

  • Confidential management of patient medical conditions, treatment, and funding information. 
  • Driving risk-based preventative intervention and care through the Schemes model and programmes, including health risk assessments (HRA’s), hospital and home visits assessments. 
  • Clinical coding per CPT4 and ICD10 requirements and as per client standards.
  • Managing patient hospitalisation; including the receipt and verification of hospital clinical updates, coordinating the appropriate Level of Care (LOC) and Length of Stay (LOS), and containing hospital stay financial risk (discharge planning).
  • Provide continuous, complete, and accurate updates and discharge information.
  • Review the costs to ensure cost-effectiveness and necessary care; balance cost and effectiveness of treatment to optimise access to care and facilities.
  • Keep the medical advisor/s, scheme management, providers, and members informed, including the interpretation of medical reports, facilitating clinical decision-making, and the efficient escalation of challenging and unresolved cases – including reporting.
  • Interact with service providers relating to funding levels and updates.
  • Manage patient chronic conditions through the active disease management programmes.
  • Telephonic and written contact with all stakeholders, including but not limited to members, healthcare providers and the client. 

Experience:

  • Seven or more years’ experience as a senior in a hospital setting. 
  • Experience as a Wellness nurse within a retail pharmacy/wellness service provider will be advantageous. 
  • Experience within a medical scheme/managed care organisation will be advantageous. 
  • Legal knowledge, i.e. Medical Schemes Act, POPIA, medical liability, etc. 
  • Knowledge of the South African Healthcare industry coding structures i.e. ICD10, CPT4, NRPL, PMB conditions and clinical protocols, etc. 
  • Extensive clinical knowledge related to all aspects of patient management, including home care. 
  • Excellent telephonic and written communication skills (will be tested). 
  • Computer literacy, MS Office – especially intermediate knowledge of Excel (will be tested) and experience with an industry information system (e.g. hospital, medical scheme administration, or managed care). 
  • Proficiency in English – verbal and written. 
  • Proficiency in Afrikaans.
  • Strong organisational, task prioritization, and multitasking skills. 
  • Ability to research and analyse information. 
  • Maintaining confidentiality of information. 
  • Decision-making skills. 
  • Following through on commitments. 
  • Flexibility to travel. 
  • Own transport and a valid driver’s license.
  • High degree of accuracy and attention to detail.
  • Self-motivator and the ability to work effectively and independently.
  • Show initiative.
  • Demonstrated ability to deal with emotionally charged and stressful situations effectively.
  • Compassionate and attentive listener – must be able to interact with the family/ loved ones of members with long-stay hospital events and members with complex disease profiles, including but not limited to chronic conditions, oncology, mental wellness, etc
  • Must be confident and comfortable with clinical decision-making.

Qualifications: 

  • Registered Nurse 
  • Valid SANC registration 


Should you receive no feedback within 7 days, please accept your application as unsuccessful.

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