Diabetes Case Manager

About the position

Purpose of the Job
Constant & ongoing development of the Disease Management Programme Reduction of risk by facilitating treatment authorization

Key Performance Areas (KPAs)

• Member retention and customer services
• Maintain risk profile of members enrolled on Disease Management Programmes
• Ensuring continuous improvement and process improvement

Job key responsibilities

• Production of educational material and dissemination to patients
• Retrospective review of related claims
• Developing and maintaining clinical protocols including new drug reviews
• Working with other healthcare personnel within the organisation
• Liaising with pharmaceutical companies
• Compilation of monthly reports detailing programme progress and areas of cost containment
• To keep abreast of benefit changes
• To develop and deliver educational presentations to employer groups.
• Other ad-hoc duties

Current knowledge of the following:

• Excellent knowledge of Chronic Disease treatments and procedures
• Clinical Protocol
• Knowledge of Prescribed Minimum benefit protocols and algorithms would be an advantage

Qualification/s

• Matric
• Registration with the South African Nursing Council
• Registered Nurse with Diabetes experience
• Medical aid/ managed healthcare experience an advantage
• Experience in disease management an advantage Experience Progression Required
• 1-2 years medical aid/ managed healthcare experience would be an advantage
• Diabetic Nurse Educator experience

Desired Skills:

• diabetes
• nurse