Disease Risk Management Consultant
- Full Time
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
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)