Case Manager

Recruiter:

Qetello Holdings

Job Ref:

1959760058

Date posted:

Saturday, March 5, 2022

Location:

Pretoria, South Africa

SUMMARY:
-

JOB DESCRIPTION:

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 case manager. Previous experience working 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 license.

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 with REF: Case Manager

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

Similar jobs you might be interested in:

Financial Manager
Location: Johannesburg
Salary: 600 000 Annually
A well-established healthcare organisation is seeking for a skilled Financial manager to oversee financial operations, strengthen financial controls, and support business performance. This role offers the opportunity to partner with senior management, deliver accurate financial reporting, and provide strategic insights that contribute to informed decision-making and sustainable growth.
Today

Legal Advisor - 24 months Fixed Term Contract
Location: Pretoria
Salary: Annually
Responsible for providing and facilitating legal advisory services in support of municipalities. The incumbent coordinates legal advisory services to ensure that company execute its legal support and advisory role to municipalities.The incumbent co-ordinates and facilitates external legal work of the organization including liaison with externallegal practitioners, government departments, municipal...
1 day ago

Internal Sales and Office Administrator
Location: Centurion
Salary: Market Related
A leading agricultural company is seeking an Internal Sales and Office Administrator to be responsible for coordinating and processing various activities, events, logistics, invoicing, procurement processes, and administrative tasks in line with company policies and procedures for the Pretoria office (and, at times, the business as a whole). The successful candidate will also be responsible for pr...
3 days ago

Financial Manager
Location: Johannesburg
Salary: 600 000 Annually
A well-established company in the healthcare industry is looking for an experienced Financial manager to lead and oversee the full finance function. This role is suited to a detail-oriented and proactive professional who can drive financial performance, maintain strong controls, and partner closely with management to support reporting, strategic planning, and informed business decision-making.
3 days ago

Commercial Finance & Business Modelling Intern (Graduate Workplace Learning programme)
Location: Johannesburg
Salary:
Signa Opportunity is recruiting unemployed graduates for the Graduate Workplace Learning Programme.Job Purpose:The Commercial Finance & Business Modelling Intern (CFBM) forms part of Signa Opportunity's Graduate Workplace Learning Programme and provides commercial finance, business modelling, and decision-support capability to the organisation.The CFBM contributes to the financial sustainabili...
18 days ago

2181 Front-End Developer (Advanced)
Location: Menlyn
Salary:
ESSENTIAL SKILLS:AngularOpenShift / Docker / KubernetesJenkinsJavaScript / TypescriptExperience building responsive layouts with CSS and HTMLAWS CloudAny additional responsibilities assigned in the Agile Working Model (AWM) CharterADVANTAGEOUS SKILLS:Web and digital project experienceAgile working experienceWebpackSonarQubeExperience working with a team of UX designersExperience with Continuous In...
25 days ago

Customer Service Conultant
Location: Johannesburg
Salary:
Every great customer experience starts with someone who knows how to listen, solve problems, and build trust.
29 days ago

Group Human Capital Manager
Location: Bryanston, Gauteng
Salary: Salary, vehicle, bonus
The GHCM is responsible for operational execution of the Group''''s human capital strategy as set by CEO, ensuring HR policies, processes, systems, and people practices are consistently implemented across business units, delivering an efficient, compliant, and employee-centric HR function.
36 days ago

Group Human Capital Manager
Location: Johannesburg
Salary: Salary, vehicle, bonus
The GHCM is responsible for operational execution of the Group''''s human capital strategy as set by CEO, ensuring HR policies, processes, systems, and people practices are consistently implemented across business units, delivering an efficient, compliant, and employee-centric HR function.
36 days ago

Imports Manager
Location: Midrand
Salary:
54 days ago

Case Manager

Similar jobs you might be interested in:

Create a free job alert for Case Manager in Pretoria

Jobseekers

Recruiter

General