Professional Nurse: Disease Risk Management Case Manager needed at Momentum Metropolitan Holdings Limited

Role Purpose    

• To support the optimisation and management of a cost-effective managed healthcare system, aimed at promoting the efficient use of healthcare resources and controlling the associated costs.

Requirements    

• A National Senior Certificate is required
• A Nursing Diploma or Degree is essential
• Minimum of 2 years clinical experience within the healthcare industry
• The incumbent must be registered with the South African Nursing Council (SANC) as a professional nurse
• Good understanding of the medical scheme industry is advantageous
• Previous experience in a managed care environment would be an advantage
• Previous experience in Primary Healthcare is advantageous with experience in HIV and TB management as per the NdoH guidelines
• Additional experience and certificate in wound care or diabetic care would be advantageous
• MS 365 proficiency

Duties & Responsibilities    
Management of chronic diseases including but not limited to; HIV and AIDS MANAGEMENT/ Management of TB infected patients, Diabetes Mellitus, Hypertension, Cardiac, COPD & Asthma, Mental illness, and chronic kidney diseases

• Register and onboarding of HIV and TB patients.
• Approval of TB and HIV medication according to HIV & TB Management guidelines and protocols.
• Face to face and telephonic adherence counselling for chronic defaulters including HIV and TB.
• Care plan and medicine adherence counselling to achieve clinical outcomes per condition.
• Liaise with providers or members to optimise treatment and adherence.

Management of high-risk conditions/ high-cost cases

• Liaise with providers on chronic condition management and assist in discharge planning and follow up and support.
• Authorise and manage home based care including palliative, Stoma therapy, wound care and home nursing as per the schemes clinical policy and guidelines.
• Work together with in hospital risk management teams to provide a holistic intervention.
• Engage with the medical advisor and treating provider to optimally manage members in a home setting and prevent hospitalisation.

Oncology Programme

• Register and onboarding of oncology patients.
• Oncology treatment plan authorisations according to ICON protocols and guidelines.
• Medical advisory referrals for out of protocol treatment requests.
• Support members during treatment.
• Care co-ordination for palliative or end of life care treatment plans.

Maternity Programme

• Register and onboarding of maternity patients.
• Educate and support during pregnancy based on risk.
• Post-partum telephonic follow ups.
• Authorisation of NIPT testing as per clinical protocols and scheme benefits and rules.

Competencies    

• Telephone etiquette & communication – verbal and written
• Accountability
• Planning and organising
• Problem solving
• Time management
• Attention to detail
• Relationship building and interpersonal understanding
• Customer orientation and results orientation
• Empathy
• Teamwork and cooperation
• Responsibility and ownership
• Business administration skills

Deadline:10th December,2025