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    Health Programme Coordinator-Middelburg, Mpumalanga - Pretoria, South Africa - MNA Recruitment

    MNA Recruitment
    MNA Recruitment Pretoria, South Africa

    1 week ago

    Default job background
    Full time
    Description

    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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