Care Coordinator Pretoria - Pretoria
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Purpose of the position: The Disease and Care Coordinator will render active disease management, clinical care support, coaching and health education services to medical scheme beneficiaries who are registered for, and lives with one or more of the Chronic Disease List (CDL) conditions by integrating the clinical care and self-management aspects for all medium and high-risk beneficiaries. He/ She will be an integral part of the clinical and disease management teams and will assist, guide and intervene with beneficiaries on how to achieve and sustain health outcome goals with a reduction in “health years”. Summary of Responsibilities: Integrates skills and knowledge of pathophysiology, epidemiology, clinical management, conditions, and self- management of chronic conditions into clinical practice. Advocates for and communicates about improved quality of care and outcomes for those living with, are at risk for or affected by chronic conditions. Performs comprehensive assessments for each patient including emotional and behavioral health. Interprets personal health data, develops an individualised care plan based on the patient's assessed needs and goals and promotes successful self-management. Facilitates follow-up and review of relevant pathology and other disease monitoring tests and interventions by engagement with the patient and/ or treating service provider subject to the registered care plan or upon request. Document all individual contacts and outcomes data in accordance with the guidelines in a timely manner. Identifies partially controlled patients and intervenes appropriately by liaising with the treating provider to manage the patients at risk. Provide assistance to clinical case management and preauthorisation team members with hospital admissions and patient outreach efforts as appropriate. Prepare reports/ case studies as required. Performs other duties as assigned within the Managed Healthcare environment. Qualifications and experience: Registered Nurse (additional post graduate certificate or diploma in counselling and/ or psychology will be advantageous) or skilled Clinical Associate (Bachelor of Clinical Medical Practice (BCMP)) Valid up to date SANC or HPCSA registration. A minimum of 3 years' experience in Disease Management/ Care Coordination, clinical patient management and health education within a Managed Care environment working with beneficiaries who are registered with one or more chronic disease condition. Maternity wellness program experience will be advantageous. Dispensing license for nurse practitioners with a focus on the treatment of non-communicable diseases (NCDs) will be advantageous. Skills Required: Comprehensive knowledge, skills and experience in chronic disease management and patient health education and monitoring. Patient centric. Excellent telephonic and written communication capability. Excellent listening skills and an ability to relate to people. Sensitivity and empathy. Ability to cope with emotional situations. Good organisational and task prioritisation skills. High degree of accuracy and attention to detail. Excellent report writing skills – case studies of high risk and/or high-cost cases, have to detail outcomes. Must be able to work with a diverse patient population and have exceptional customer service skills. Proficient with MS Office (Outlook, Word, Excel) (knowledge and understanding of medical scheme administration and/ or managed care information systems will be advantageous) Must be able to function within a team. The ability to speak more than two of the national languages will be advantageous. R300 000 - R420 000 TCTC
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