HEAD OF DEPARTMENT: DISEASE RISK MANAGEMENT
JHB
Managed Healthcare

A challenging opportunity exists for an individual who will provide strategic direction aimed at enhancing broader access of the Company’s products and services to members of medical aid schemes, as well as ensure that the Company is a key player in the provision and delivery of managed healthcare services specifically disease management through forging close ties with key stakeholders.

Provide new and innovative managed healthcare solutions within the health insurance industry.

Manage the disease management programmes to ensure successful implementation and measurement of outcomes. Disease Management programmes include High Risk patient management, Oncology, Psychiatry, Prosthesis, Organ Transplant and Renal.

This position reports directly to the Chief Operations Officer.

THE IDEAL CANDIDATE SHOULD HAVE:
• A minimum of a Grade 12
• Formal Clinical qualification i.e. Pharmacy degree or other Healthcare related degree/diploma.
• Min. 5 yrs’ work experience in the Managed Healthcare environment essential.
• Min. 3 yrs’ Management experience essential.
• Member of appropriate professional medical body
• Clinical protocol development an advantage
• Disease management programme implementation and management essential with proven track record
• Exposure to Managed HealthCare policies and procedures, ISO principles and other CMS and DoH related legislature including PMBs essential.
• Planning and organising skills.
• Excellent communication skills (both verbal and written communication)
• Computer literacy (MS Office and Medical Administration system and Data warehouse).
• The ability to use data collection techniques and methods for analysing, identifying trends and reporting on data. Strong reporting focus
• Knowledge of QlikView will be an advantage


KEY RESPONSIBILITIES INCLUDE
• Implementation and Ongoing development of the Disease Management Programmes.
• Compile detailed plan of disease management programmes including risk rating and monitoring.
• Manage current project plan to ensure implementation within agreed timelines.
• Communicating with prescribers, patients and the Fund with regards to the programme rules; disease education and related clinical information.
• Production of educational material and dissemination to patients.
• Develop and maintain clinical intervention protocols and strategies for specific diseases.
• Compilation of monthly reports detailing programme progress and present to Executive and client.
• Manage the schemes Specialist Profiling programme.
• Manage and monitor other outsourced care coordination programmes/ third party arrangements to ensure outcome agreed upon are achieved.
• Management of staff
• Ensure that the department meets agreed Scheme SLA’s and company targets.
• Promote and adhere to Company Values

Closing date: 20 September 2017