Case Manager

SUMMARY:
Arcadia, Pretoria.

POSITION INFO:

Functions:

• 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 hospitalized 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.
• Coordinating 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 hospitalized 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 authorization notes to doctor, members, suppliers and service providers.
• Identify and manage complicated and high-cost cases that have a financial impact on the scheme

Requirements:

Grade 12

Completed Degree / Diploma as a Registered Nurse

Must be registered with SANC

2 years experience in manage Healthcare

Must possess knowledge of the following:

• IDC-10 & CPT Coding
• Company medical schemes rules
• ERP
• Workflow
• CAM
• Computer literate MS Office Suite 
• Must have a K53 drivers Licence
•  Successful completion of the selection of the criteria that determine the candidate''''s potential with regards to the following competencies 
• Customer focus
• Good verbal and written English communication skills as well as proficiency in understanding Afrikaans spoken and written communication
• Teamwork
• Negotiating Skills 
• Decision Making
• Must be able to work under stress and deadlines

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