Disease Management Specialist

SUMMARY:
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POSITION INFO:

Job Title

Disease Management Specialist

Position Purpose

To provide information, advice and explanations on clinical outcomes or systems of a complex clinical nature or to resolve complicated
process challenges. To ensure the effective use of the relevant healthcare benefits and system to optimise targeted communication
interventions telephonically and digitally, according to the clinical guidelines to ensure the GEMS disease management outcomes are achieved.

Experience

Minimum 5 years managed healthcare experience. Comprehensive knowledge of scheme rules, operational clinical process, and systems is essential.
Knowledge of internal business processes.

Qualifications

Relevant clinical qualification (registered nurse or pharmacist).

Accountabilities

Continuous improvement:

• Conduct comprehensive post implementation reviews and resolve user issues
• Develop and present relevant and accurate support documentation
• Conduct planning and prioritisation of user issues related to area of expertise and in line with business priorities
• Implement practical solutions that use the specialist and departmental systems and processes
• Provide specialist input and recommendations to improve the efficiency, compliance and quality objectives related to the area of specialisation
• Identify problems and develop and propose solutions to present to appropriate leader or stakeholders
• Ensure day to day operational support required from area of specialisation is provided to enhance performance