Permanent
Pretoria
Posted 4 months ago

Together with our client, we are recruiting for a Case Manager in Pretoria.  The Candidate must be a Registered Nurse with SANC and have at least two years of clinical experience after registration.  Previous working experience 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 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

  • R354 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 werner@medicalresources.co.za with REF: Case Manager

Job Features

Job CategoryRegistered Nurse

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