Case Manager-Clinical Nurse

SUMMARY:
Case Manager-Clinical Nurse:

POSITION INFO:

A vacancy exists for a Registered Nurse OR Enrolled Nurse, for a medical insurance company. job description will include:

• Hospital pre-authorisation and issuing guarantee of payment
• Telephonic assessment of patient''''s and risk profile, Approve/assess clinical treatment plans
• Define desired clinical outcomes for the patient and prevent re-admission to hospital
• Telephonic case management and resolution of resultant queries within service levels
• Evaluating patients progress at predetermined intervals and referring when appropriate
• Investigating problems and high cost cases (hospital and chronic cases)
• Work within defined SLA’s

MINIMUM REQUIREMENTS

(Educational Qualifications & Experience)

• Minimum Grade 12
• Registration as a Registered Nurse or Enrolled Nurse (with SANC)/ Paramedic (Desirable)
• Experience working in a health care setting
• Work experience in a managed care environment
• Excellent people skills and a caring approach
• Bilingual
• Good communication skills (both verbal and written)
• Good planning and prioritising abilities in order to meet targets and internal SLA’s
• An astute, logical and motivated approach
• Knowledge and experience of BHF tariff codes, ICD 10 and CPT 4 codes
• Computer Literacy in Microsoft Office (MS Excel, Outlook, word etc.)
• Good understanding of managed healthcare processes.
• Sound clinical knowledge of chronic medical conditions.

 

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

---