Back Office Case Manager
2 weeks ago
- Nursing qualification (Registered or Enrolled Nurse).
- 3 to 5 years of nursing experience, with back-office or case management experience preferred.
- Knowledge of medical scheme regulations, ICD-10 coding, tariffs, and case management protocols.
- Strong attention to detail, communication, and administrative skills.
- Computer literacy, including experience with relevant medical scheme systems.
Key Responsibilities:
- Update and manage hospital admissions according to guidelines and benefit structures.
- Conduct telephonic case management for medical and surgical cases within set financial limits.
- Monitor ongoing hospital cases, liaise with medical advisors, and negotiate discounts where applicable.
- Handle member queries regarding hospitalization, benefits, and case updates.
- Provide written communication, reports, and motivations related to case management.
- Ensure compliance with medical scheme regulations and maintain accurate case records.
- Liaise with hospitals, doctors, members, and families to ensure seamless care coordination.
- Assist with cost containment strategies, including managing prosthesis discounts and claim reversals.
- Ensure effective interdepartmental communication and contribute clinical expertise where needed.
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