Job Summary
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 Registered Nurse. Previous experience working at a Medical Aid 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 licence.
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.
To apply please send your CV and supporting documents to recruit@medicalresources.co.za with REF: Case Manager
Closing date: 10 December 2021
