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HIV Case Manager- Talent Pool

Business Unit:  Discovery Health
Function:  Case Management
Date:  14-Jan-2022

 

About Discovery Care

 

 

Discovery Care is a subsidiary for Discovery Health - made up of distinct areas with segmented teams- Chronic and PMB Management, responsible for processing  of Chronic and Prescribed Minimum Benefit requests and escalated clinical query processes while within Disease Management the HIV/Oncology and In Hospital Case Management teams are responsible for reviewing clinical cases for each of the specialized areas. The team also consists of Specialized Claims, responsible for the processing of specialized claims and High Touch made up of Healthy Company and other Health touch functions which provide hands on services and escalated query resolution to sensitive cases.

 

 

Key Purpose:

 

 

Management of enrolled HIV members by reviewing clinical appropriateness of treatment is prescribed. This involves the correct application of Clinical Entry Criteria, Protocols,

SOP’s and Clinical guidelines as well as explaining the benefit to the member and counselling the member.

 

 

 

Key Outputs:

 

 

The successful applicant will be responsible for but not limited to the following job functions:

 

 

• Enroll member on HIV Programmed and ensure that the member meets all requirements to qualify for the benefit (i.e. Forensics, Underwriting categories)

• Counsel the Member in relation to the following:

  • Knowing and understanding the disease
  • Accepting the condition/diagnosis
  • Treatment regimes and their prescribed medication
  • Terminology related to the disease and related pathology
  • Nutrition

• Review scripts and pathology from a central work pool to ensure that the member receives medication and continuous treatment

• Facilitating medication delivery through the DSP

• Drug Utilization Review (DUR)

• Applying internal disease management processes: monitoring compliance to testing doctor visits and medication

• Telephonic support to members, Chronic HIV & Oncology Service Agents, Doctors and Pharmacists

• Support to Doctors by co-ordinating treatment plans and sending them updated guidelines and information

 

 

Competencies:

 

Analysing: Analyses numerical data, verbal data and all other sources of information. Breaks information into component parts, patterns and relationships. Probes for further information or greater understanding of a problem. Makes rational judgments from the available information and analysis. Produces workable solutions to a range of problems. Demonstrates an understanding of how one issue may be a part of a much larger system.

Deciding and Initiating Action: Makes prompt, clear decisions, which may involve tough choices or considered risks. Takes responsibility for actions, projects and people.

Takes initiative, acts with confidence and works under own direction. Initiates and generates activity.

Following Instructions and Procedures: Appropriately follows instructions from others without unnecessarily challenging authority. Follows procedures and policies. Keeps to

schedules. Arrives punctually for work and meetings. Demonstrates commitment to the organisation. Complies with legal obligations and safety requirements of the role.

• Presenting and Communicating Information: Speaks clearly and fluently. Expresses opinions, information and key points of an argument clearly. Makes presentations and

undertakes public speaking with skill and confidence. Responds quickly to the needs of an audience and to their reactions and feedback. Projects credibility.

Delivering Results and meeting customer expectations: Focuses on customer needs and satisfaction. Sets high standards for quality and quantity. Monitors and maintains

quality and productivity. Works in a systematic, methodical and orderly way. Consistently achieves project goals.

 

 

Qualifications & Experience:

 

 

The following requirements are essential:

 

  • Matric
  • Enrolled Nurse or Registered Nurse
  • Registered with SANC
  • Minimum of 3 years HIV management experience
  • Microsoft Office
  • Effective Communication Skills (Verbal & Written)
  • Presentation skills
  • Telephone Etiquette
  • Active Listening Skills
  • Knowledge of HIV guidelines

 

 

 

The following requirements will be advantageous:

 

  • 2 years experience as a Case Manager
  • 1 year HIV Counseling experience
  • Project Management

 

 

 

EMPLOYMENT EQUITY   
                             
The Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.

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