Wellness Case Manager - Johannesburg, South Africa - 3Sixty Health (Pty) Ltd

3Sixty Health (Pty) Ltd

Verified Company

Johannesburg, South Africa

1 week ago

Posted by:

Thabo Mthembu

beBee Recruiter

Description

3Sixty Health has a great opportunity for a suitably qualified individual to fulfil the advertised position

3SIXTY HEALTH and join their team.

BACKGROUND 3Sixty Health is a black owned and managed, reputable and a major player in driving South African economy by investing in ''black excellence''3Sixty Health is 100% black owned and black managed administrator. It is accredited by the council for medical schemes to offer both administration and managed care services, allowing for a fully integrated, beneficiary-centric approach. Our core competencies in administration include membership management, billing, claim adjudication and customer services.

It is a medical aid administrator of Sizwe Hosmed Medical Scheme.

Wellness Case Manager

JOB TITLE

JOB GRADE

DIVISION
Disease Risk Management

Managed Health Care

DEPARTMENT

Responsible for participating in delivery of patient education and disease management interventions

JOB PURPOSE and for performing health coaching for members, across multiple lines, for health improvement/management programs for chronic diseases.

1

NUMBER OF JOB HOLDERS

Johannesburg

LOCATION

DUTIES & RESPONSIBILITIES

Liaise with service providers.
Ensure effective and efficient management of chronic

- diseases, counselling and coordinating care of patients with all chronic disease including maternity, renal dialysis, psychiatry and organ transplant,.

Overall planning and supervising of chronic disease care management activities
Ensure compliance with regulatory agencies and with established policies and procedures, research policies on conditions managed and provide input to the policies.
Patient and provider education
Interfaces with provider and other health professionals to coordinate health coaching plan for the member.
Implements and/or coordinates coaching and/or care plans by educating members regarding clinical needs and facilitating referrals to health professionals for behavioural health needs.
Support and implement Risk Event Assessment, and educational interventions.
Liaise with Medical Advisor, other managers and departments including IT to ensure efficient management of chronic diseases, and automation of services.
Psychiatry, renal dialysis, insulin pumps e.g. patients, Oxygen management, sleep apnoea management.
Application of Disease management protocols
Application of Scheme Rules in all aspects, and updating of protocols

QUALIFICATIONS AND EXPERIENCE

Registered nurse preferably with at least 5 year case management or disease management experience, and an understanding of the managed care industry and environment.
Strong maternity case management experience
Excellent knowledge of all chronic diseases and their management, interest in research and development of clinical policies and protocols
Excellent, verbal, and written communication and good interpersonal skills
Data analysis and report writing experience related to the diseases managed.
Understanding of integration of care, knowledge of PMBs and chronic diseases would be advantageous.
Code 8 drivers licence essential interpersonal skills is essential

PERSONAL ARTRIBUTES