CASE MANAGER - MANAGED HEALTH CARE

SUMMARY:
CASE MANAGER - MANAGED HEALTH CARE

POSITION INFO:

Exciting opportunity for a Case Manager to assist in the enhancement and management of a cost-effective Managed Health Care with the objective of promoting rational utilisation of Health Care facilities and containing associated costs generated by these services. 

Positions available in Centurion, KZN & Cape Town

Requirements

• Matric
• Basic Diploma in Nursing (Enrolled Nurse) or Nursing Diploma / Degree essential
• Minimum of 4 years clinical experience within the Healthcare industry essential
• Minimum of 2 years Hospital Risk Case Management experience essential
• Minimum of 2 years experience in a Managed Care environment essential
• Registered with SANC (South African Nursing Council) essential
• Good understanding of the medical aid industry i.e. trends, competitors, legislation essential
• Previous experience in a Managed Care environment essential
• Fully computer literate
• Experience in Hospital Risk Management essential

Key duties

• Arrange post hospital care where necessary.
• Educate and guide all members regarding health care and their benefits.
• Develop, implement and communicate the practice and/or the clinical guidelines for cost effective care.
• Authorise appropriate and cost effective surgical care and treatment.
• Ensure the consistent and correct application of exclusions.
• Adhere to policies and procedures and take corrective action where necessary.
• Adhere to organisational best practice and legislative requirements.
• Take ownership of escalated and unresolved queries and ensure they are resolved timeously.
• Manage the problem until resolution, updating the incident detail with any status updates.
• Ensure the effective, accurate and timeous completion of relevant documentation accompanying transactions.
• Communicate with providers to improve the cost efficiencies of health care delivery.
• Provide clear communication with regards to the outcomes and process.
• Ensure Service Level Agreements are met and exceeded.
• Engage in effective communication and delivery according to Service Level Agreements.
• Adhere to all procedures and processes to improve service delivery.
• Manage cost of an in or out-patient episode by implementing appropriate policies and guidelines.
• Identify financial and business risks to the company and escalate accordingly.
• Drive and support effective teamwork within the department.
• Engage in appropriate training interventions to promote own professional development.
• Ensure to demonstrate the company''''s values on a daily basis

NB! This job is now closed. You can apply for other jobs by uploading your CV.