Key Purpose :
To holistically review the needs of clinically complex members and coordinate their care in the most appropriate setting, liaising with internal and external stakeholders to ensure the best clinical outcomes.
Key Outputs
Perform health assessments on patients in order to identify individual patient risk factors
Perform interventions to influence individual patient risk
Promote behavior change to ensure greater treatment compliance and condition management
Authorising of admissions and treatment as per agreed protocols
Assist members with clinical related queries
Proactively assist complex member with understanding their plan benefits and maximizing their use to effect risk savings in the long term
Monitor patient progress through ongoing patient interaction and follow-up.
Co-ordination of integration of care including social services where appropriate.
Maintain relationships between key internal and external stakeholders
Refer to other departments where appropriate to ensure that the relevant benefits are provided
Education and Experience:
The following requirements are essential:
Matric
Registered Nurse qualification
Valid SANC registration
MS Office
At least 3 years clinical nursing experience, post training.
The following requirements will be advantageous:
Managed care experience
Discovery Health system knowledge and experience