Health-Programme-Coordinator

One of our clients in the Health Care industry has a vacancy available for a Health-Programme Co-ordinator in Middelburg.

The ideal candidate will be a mature individual (older than 40-years of age) with more than seven years experience

within a hospital case management position. Must be eager to learn, healthy and fit. Needs to be able to speak and

understand Afrikaans. PLEASE NOTE: ONLY APPLY IF YOU QUALIFY IN FULL

Weekly rotation - 07H00 to 16H00 or 08H00 to 17H00 (Monday to Friday).

Telephonic standby every third week.

Qualifications

• Registered Nurse
• Valid SANC registration

Skills, Competencies, And 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.
• Strong organisational and 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 drivers license.

Ability:

• High degree of accuracy and attention to detail.
• Self-motivator and the ability to work effectively 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.

Summary of Responsibilities:

• Confidential management of patient medical conditions, treatment, and funding information.
• Driving risk-based preventative intervention and care thorough the Schemes model and programmes, including health risk assessments (HRAs), hospital and home visits and 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 contain hospital stay financial risk (discharge planning).
• Provide continuous, complete, and accurate updates and discharge information.
• Review the costs to ensure cost-effective 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.