SUMMARY:
Case Manager - Registered Nurse
POSITION INFO:
Job Title: Case Manager - Medical Aid
Location: Tshwane Metro, Pretoria, Brooklyn
Job Type: Permanent, expected to work Full-Time hours
Primary Industry: Insurance
Secondary Industry: Health, Medical and related
Job Duties:
- Plan and optimise daily tasks to update cases on the hospital list within the 8-hour turnaround time
- Follow 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 team
- Manage telephonic calls and inquiries from all clients and service providers
- Co-ordinate services and care for members to prevent re-admissions and complications
- Negotiate within the scheme rules regarding tariffs and discounts
- Identify hospitalised members for transfer to rehabilitation sub-acute and private nursing facilities
- Initiate discharge planning early in hospital admission
- Inform family regarding short-term medical benefits and educate them regarding general care exclusions
- Communicate with relevant parties about the discharge plan and benefits
- Document all phone calls made to relevant parties
- Complete and document all relevant information
- Communicate clinical funding recommendations via hospital authorisation notes to doctors, members, and support staff
- Identify and manage complicated and high-cost cases that have a financial impact on the scheme
Required Qualifications:
A completed degree or diploma as a registered nurse
Must be registered with the South African Nursing Council (SANC)
Experience, Knowledge and Skills:
- Four years experience in Managed Healthcare with oncology and or experience in a oncology unit
- Prior experience in a similar role
- Ability to manage and prioritise workload effectively
- Strong communication and interpersonal skills
- Excellent negotiation skills
- Knowledge of hospital procedures and medical terminology
Preferred Qualifications:
Additional certifications in case management or healthcare management
Working Conditions: The role involves working in an office setting, handling phone calls and interacting with clients and healthcare providers on a regular basis.
Company Branding: Medihelp is the proud medical aid of choice for more than 215,000 South Africans. We welcome employees who share our vision of shaping healthy, confident South Africans making the most of every life stage.
Closing date: 23 July 2024
NB! This job is now closed. You can apply for other jobs by uploading your CV.
