Position Purpose: To educate and support members with the aim of empowering them to manage their disease better thereby improving their health outcomes and limiting healthcare costs whilst maintaining quality of care. Experience: 5 years relevant managed care, health risk and clinical customer service within Medical Scheme Administration Industry or similar. Solid working experience with the following: HIV, Oncology, Diabetes, Asthma, Renal Failure and Cardiac diseases, mental health management and holistic management of these conditions Motivational counselling and health education techniques Qualifications: Registered Nurse with medical diploma/degree and valid SANC registration (MANDATORY REQUIREMENT) Accountabilities: Client service delivery and quality Follow procedures and cooperate with peers and leader for best possible service delivery Contribute to cost savings within the department to assist with financial goals and targets Continuous improvement Operation Model Meet delivery objectives through working with other team members within and linked to the department / project Resolve operational performance variations and problems and elevate unresolved issues to higher levels Ensure delivery targets/objectives are met and operate in a supportive manner to achieve successful delivery Provide appropriate and impactful telephonic and written counselling, education and support to allocated clients with high risk or long‑term illnesses, thereby reducing hospital admissions and risk factors Complete required administration and case information on assigned cases to standard and within deadline Handle and resolve medical and claim related fund queries Identify high risk patients and clients and, when appropriate, refer to alternative professionals for additional support (such as social workers) Maintain a high level of impact on other departments to support improved delivery – Continually increase understanding of client and stakeholder needs, satisfaction and service delivery Be a member of related professional bodies Ensure CPD (continual professional development) or similar accreditation requirements are met annually to maintain specialist accreditation Operational Implementation of Strategy Keep up to date with operational changes implemented in response to important external factors Deliver in a manner that supports and meets operational quality standards and the defined departmental objectives Perform according to defined operational best practice and identify and implement opportunities for continuous delivery improvement Deliver personal performance within Human Capital frameworks and policies to ensure delivery to agreed standards and objectives. Engage in development, coaching and support transformation through valuing Stakeholder Management Ensure appropriate, active, and informative relationships with customers and relevant stakeholders are successfully maintained Address customer or stakeholder complaints in alignment with the policies and procedures and ensuring customer / stakeholder buy-in. KEY PERFORMANCE AREAS Logical exploration of problems with innovative solutions Able to work with and encourage participation in a team Able to handle concurrent duties Committed to good business practices, maintaining an effective internal control environment Able to manipulate data to produce useful management insights KEY COMPETENCIES Experience Understanding of disease management processes and the relevant disease areas Able to communicate effectively with and influence others, including negotiation and telephone skill sets Knowledge Knowledge and application of processes and procedures Knowledge and application of relevant legislation Product and scheme rule knowledge Skills Good business practices, maintaining an effective internal control environment Time management Analytical ability Numerical ability Attention to accuracy and detail Problem solving Customer focus Communication skills Note: Company reserves the right to close the advert before specified closing date. PHA has its head office in Westville, KwaZulu-Natal. It operates country-wide with a nationally linked network and uses a robust, flexible, as well as integrated system to ensure efficient and effective administration of membership and benefits. #J-18808-Ljbffr