Contacting members and building positive relationships with the members to achieve positive outcomes.

Analyze and interpret reports, clinical results, and patient history information to provide an action plan per patient.

Ensure adherence to Scheme Rules on all authorizations and clinical updates.

Effective handling of Internal/External Clinical Queries Communicate with

members and service providers to address disease management matters.

Assist with Health Risk Management Monitoring & Management of hospital re-admissions.

Compile & submit detailed reports to the Scheme on costs and patients progress.

Educate members on their chronic conditions via email or telephonically.

Support the Service Manager and HOD on any projects related to risk

management.

Grade 12

A Registered Nursing qualification

Disease Risk Management is essential

Sound knowledge of the Coding Systems: ICD10 & Principles and sound

knowledge of the Medical Aid Industry, Rules & Regulations, ISO, and other related legislation

Excellent business writing & communication skills with exceptional telephone etiquette

Must have strong organizational awareness to anticipate the impact of actions on other groups

Time Management & good administration skills

Effective conflict resolution skills and the ability to work under pressure

Must be a strong team player and results-driven

Computer literacy (MS Office and Medical Administration system)