Case Manager

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.