Case Manager (Spinal Programme Management

PLEASE NOTE THAT NO CV'S WILL BE KEPT FOR FUTURE USE. ONLY APPLY IF YOU QUALIFY IN FULL.

INTRODUCTION
Our client is an accredited managed health organisation that service clients in the medical scheme industry. They are privileged to have one of the growing medical schemes in South Africa as a client and a new opportunity and position has presented itself in their commitment to ensure that our medical scheme beneficiaries are supported to access healthcare services.

PURPOSE OF THE POSITION:
To actively manage the access, clinical appropriateness and risk (both financial and clinical) of all requests for services pertaining to back and neck pain management, spinal surgery, scans and associated healthcare services in accordance with the relevant scheme rules, clinical protocols and funding guidelines.
To critically consider and propose relevant treatment alternatives that include, but are not limited to, conservative treatment options like physiotherapy.
To participate in the clinical review of exceptional cases and to engage with various stakeholders including treating providers, hospital case managers, medical advisors and colleagues.

QUALIFICATIONS:

• Registered Nurse with valid registration with SANC

OR

• Clinical Associate (Bachelor of Clinical Medical Practice (BCMP)) with valid registration with HPCSA

SKILLS AND COMPTENCIES REQUIRED:

• Thorough, well-grounded clinical knowledge of hospital admissions, LOS and LOC.
• Excellent knowledge of the South African Healthcare industry and prevailing legislation, current coding structures i.e. ICD10s, CPT4, NRPL, PMB conditions and clinical protocols
• Extensive clinical knowledge related to all aspects of holistic patient management.
• Work experience within Orthopaedic and/ or Surgical theatre and wards will be advantageous.
• Solid understanding of value-based care.
• Demonstrated ability to manage a portfolio of active patient cases and to accurately update and maintain patient case information.
• Outcome focused with the ability to manage competing demands
• Establishing and maintaining effective relationships with key stakeholders.
• Excellent telephonic and written communication skills (will be tested)
• Computer literate - MS Office Suite (intermediate) required.
• MIP Application System experience will be advantageous.
• Reporting MS Excel (intermediate) required (will be tested)