Case Manager - Healthcare

Recruiter:

Stafflink Recruitment Solutions

Job Ref:

STL 2148

Date posted:

Tuesday, April 19, 2022

Location:

Pretoria, South Africa

Salary:

R445 200 CTC plus allowance

SUMMARY:
Pretoria

JOB DESCRIPTION:

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 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

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

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