MVG Recruitment Specialists Johannesburg, Gauteng Posted 15 Jul 2021 by MVG Recruitment Specialists Experience: Total of 5 - 8 Years in Managed Care Large Managed Care organisation seeks to employ experienced Specialist Case Manager for Member Risk Management. Responsible for High-Risk / High-Cost Members, assist with ensuring management of patient specific healthcare with multidimensional risk management interventions.You should have experience in drawing up of individual healthcare plans based on the individual high risk members condition with extensive knowledge on various health conditions to suitably manage their health and the aim of improving their health. You will have knowledge on treatments, medications, Healthcare Specialist and other healthcare interventions that would be required to assist in managing the members healthcare. You will be required to keep an accurate track record on the members healthcare progress showcasing the improvement of their health and high claims status. This will require you to liaise with their various Healthcare Providers and other stakeholders. It is important to have the suitable financial acumen when drawing up the individual healthcare plan too. You will be required to do presentations for Management on your individual healthcare plans for the various high-risk members showcasing the track record, health improvement, along with financial improvement on the high-cost claims etc. Key Requirements: Registered Nssurse or suitable qualification as a Clinical Associate Total of 5 - 8 Years in Managed Care 3 to 5 years' experience advising healthcare on various health conditions of high-risk members care in the Managed Care /Medical Scheme sector Experience in Disease Risk Management and proactively advising member on best care to manage their health to ensure improvement thereof to the best interest of the member and scheme Expertise in clinical guidelines and chronic conditions / disease management Expertise in drawing up individual healthcare plans based on the members condition with the aim to support and improve health, taking into consideration full health management aspects of the plan (treatments, medication, specialist etc.) Improve members health and minimise high claims risk Good knowledge on medications Expertise in ICD10 codes and various clinical coding Coordinate with various Health Professionals and stakeholders regarding the members care Ensure to follow up and keep track of various members care Accurate report keeping and feedback on progress Presentations for Management on the various required aspects regarding Member Risk Management Clinical Analysis Report writing skills Valid Drivers License and own vehicle Visits when and as required To apply submit application to [Email Address Removed]. Copy of Matric Certificate Copy of Qualification as Nurse or in other suitable Clinical Healthcare Copy of SANC Registration Copy of valid Drivers License Comprehensive CV detailing your Member care experience in Managed Care Desired Skills: 3 to 5 years' experience advising healthcare on various health conditions of high-risk members care in the Managed Care /Medical Scheme sector Desired Work Experience: 2 to 5 years Desired Qualification Level & Accreditations: Headquartered in Cape Town. Medical and Pharmaceutical Recruitment Specialists; Specialising in the placement of pharmacists, pharmacist assistants, nurses and technical staff into all areas of the medical/pharmaceutical industry nationally in South Africa. APSO Registered.LEVEL 1 BBBEE Certified Receive a daily digest of all new jobs matching this job. Your information is safe with us and you can cancel any time.
