Case Manager

Together with our client we are recruiting for Case Manager in Pretoria. The Candidate must be a Registered Nurse with SANC and have at least two years’ experience after registration as case manager. Previous experience working at a Medical Scheme would be an advantage.

Duties and Responsibilities


• Plan and optimize daily tasks to update cases on the hospital list within the 8 hours turnaround time.
• Following up on long term and high cost cases of hospitalised and home care patients.
• Identify the need for patient and hospital visits where possible and give documented feedback.
• Follow the escalation process for the referral of cases that require input from management or the medical advisor.
• Managing telephonic calls and enquiries from all client and service provides.
• Co-ordinating services and care from which a member will benefit to prevent re-admissions and complications.
• Negotiations within the scheme rules regarding tariffs and discounts.
• Identifying hospitalised members for transfer to rehabilitation, sub-acute and private nursing facilities, for quality cost effective services.
• Initiate discharge planning early in hospital admission.
• Inform family regarding short term medical benefit and educate them regarding general care exclusion.
• Communicate with relevant parties about the discharge plan and benefits.
• Document all phone call made to relevant parties.
• Complete and document all relevant information.
• Communicate clinical funding recommendations via hospital authorisation notes to doctor, member, suppliers and service providers.
• Identify and manage complicated and high cost cases that have a financial impact on the scheme

Job requirements


• Grade 12.
• A completed degree or diploma as a Registered Nursing and must be registered with SANC.
• Two (2) years’ experiences in Managed Healthcare.
• Must possesses knowledge of the following:
• ICD-10 & CPT coding;
- Medical scheme’s rules;
- ERP;
- Workflow;
- CAM
• Computer literate in MS Office.
• Must have a K53 driving license.

Must possess the following skills:


• Customer focus;
• Good verbal and written English communication skills as well as proficiency in understanding Afrikaans spoken and written communication.
• Teamwork;
• Negotiation skills;
• Decision making;
• Must be able to function under stress.

Salary


• R334 194 - R420 000 CTC per Annum


Benefits


• Pension Fund
• 13th cheque
• Medical Aid


Only candidates who meet all the requirements stipulated in this advert, will be considered. If you don’t receive feedback from us within 2 weeks of your application, please consider your application as unsuccessful.