Large managed care organisation (Cape Town) seeks to employ a DRM Case Manager to promote quality, cost effective outcomes in order to manage and reduce the clinical and financial risk of the product.
Key Responsibilities:
- Act as liaison between member, service provider and the healthcare team
- Identification of high risk cases for referral to medical advisors for further clinical opinion
- Regular monitoring of the DRM plan’s effectiveness in achieving the desired outcomes
- Monitor and evaluate treatment requirements and educate high risk members
- Ensure SLA’s with clients and service providers are maintained
- Assist with all managed care functions, including HIV and Oncology Case Management when required
- Load all cases onto the company system and facilitation of patient education
- Development of comprehensive case management plans
Required:
- Advanced knowledge of Managed Care principles, processes and protocols
- Good PMB and Coding knowledge
- Current registration with SANC and Diploma/ Degree in Nursing (Non-negotiable)
- At least 4 years within Disease Management with 2 years within Oncology/ HIV Case Management
To apply submit application to response “at” [URL Removed]
Supporting documentation required:
- Copy of Matric Certificate
- Copy of Nursing Diploma/ Degree
- Copy of SANC Registration
- Comprehensive CV detailing your Case Management experience
Desired Skills:
- At least 4 years within Disease Management with 2 years within Oncology/ HIV Case Management
Desired Work Experience:
- 2 to 5 years
Desired Accreditations:
- South African Nursing Council