Location: Centurion, Gauteng

Reporting to: Clinical Operations Manager

 Position Type: Permanent 

Position Purpose: To educate and support members with the aim of empowering them to manage their disease better thereby improving their health outcomes and limiting healthcare costs whilst maintaining quality of care.

Experience: 5 years relevant managed care, health risk and clinical customer service within Medical Scheme Administration Industry or similar.

Solid working experience with the following:

• HIV, Oncology, Diabetes, Asthma, Renal Failure and Cardiac diseases, mental health management and holistic management of these conditions
• Motivational counselling and health education techniques

 Qualifications:  Registered Nurse with medical diploma/degree and valid SANC registration (MANDATORY REQUIREMENT)

KEY COMPETENCIES

Clinical Knowledge and Expertise
In-depth understanding of chronic diseases (e.g., diabetes, hypertension, HIV/AIDS, asthma, heart failure).
Ability to interpret diagnostic results and clinical guidelines. Understanding of disease management processes and the relevant disease markers
Knowledge of medication management, treatment plans, and comorbidities.

Patient Education and Advocacy
Educating patients on disease management, prevention, and lifestyle modification.
Promoting self-care practices and adherence to treatment plans.
Empowering patients to take an active role in their health.

Communication and Interpersonal Skills
Strong verbal and written communication with patients, families, and healthcare professionals.
Cultural competence and emotional intelligence.
Conflict resolution and motivational interviewing skills.

Data Analysis and Reporting
Using data to track patient outcomes and program performance.
Familiarity with health information systems and electronic medical records.
Applying evidence-based practices based on patient data.

Problem Solving and Critical Thinking
Assessing complex cases and making informed decisions.
Identifying care gaps and potential risks to patient outcomes.
Prioritizing interventions based on clinical urgency and resource availability.

Regulatory and Ethical Compliance
Understanding healthcare policies, privacy laws (e.g., HIPAA or POPIA in South Africa), and medical ethics.
Adhering to guidelines for quality assurance and risk management.

Time Management and Organizational Skills
Managing caseloads efficiently.
Balancing administrative and clinical responsibilities.

Knowledge
Knowledge and application of processes and procedures
Knowledge and application of relevant legislation
Product and scheme rule knowledge

Skills
·    Risk management
·    Good business ordinance, maintaining an effective internal control environment
·    Time management
·    Analytical Ability
·    Numerical Ability
·    Attention to Accuracy and Detail
·    Problem Solving
·    Customer Focus
·    Communication Skills