Health Programme Coordinator-Pretoria - Pretoria
MNA Recruitment
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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