Field Case Manager

6 days ago


Johannesburg North, South Africa Sotina Recruitment Full time

Job Summary : To plan, coordinate and execute case management work for RAF Business in the CHG Facilities. The incumbent utilises clinical and RAF knowledge in managing RAF Business in the facilities to minimise financial risk and ensure accurate billing through comprehensive accurate coding and classification of RAF available products offered in the facilities, Authorization of these products to ensure that they will be fully reimbursed. Minimum work experience : To collaborate with the fund in ensuring that the patient/claimant have access to quality healthcare services from both Acute and Rehabilitation to achieve good clinical outcomes and reintegration back to the society. To establish a framework in enhancing service delivery to patients with due attention to the Fund`s financial obligation and payment processes. Conduct site case management through visits to different CHG facilities and Government facilities where CHG has signed MOA with and share clinical updates with the fund. Obtaining approval of care based on the Fund`s treatment protocols and an appropriate referral system for specialized management. Establish working groups with sufficient representation from the Fund and facilities to enable good clinical governance. Consult daily with all relevant health care providers with regards to patient treatment. Investigate and understand Funder, Doctors, Nurses and Patient needs to enable delivery of a quality service Ensure service knowledge and advice is technically accurate and provide stakeholders with relevant information to keep them informed of products and service options. Ensure conflict resolution and respond to any complaints or concern. Maximize revenue by applying clinical judgement to Length of Stay (LOS), Level of Care (LOC), formulary utilization, assistive devices / Prosthesis, diagnostic interventions, therapy intervention and procedural interventions and required change in the facility Ensure complete, timeous and accurate reporting with appropriate levels of escalation to enable effective decision-making. Diploma/ Degree in General Nursing or Business-Related qualification. 3-5 years experience as RAF Case manager/Claims Adjudication Unit. Knowledge of ICD-10 and CPT coding. Knowledge of RAF Industry


  • Case Manager

    7 days ago


    Johannesburg, South Africa Clinix Health Group (Pty) Ltd Full time

    **Job Summary**: To deliver an effective case management process and facilitate the communication process between all role-players by providing accurate and timeous clinical information in order to minimize the financial risk for the company. **Minimum Qualifications and Experience**: - Grade 12. - Registered Nurse, currently registered with SANC. -...

  • Case Manager

    6 days ago


    Johannesburg, South Africa Clinix Health Group (Pty) Ltd Full time

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  • Case Manager

    7 months ago


    Johannesburg, South Africa Mass Staffing Projects Full time

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  • Case Manager

    7 months ago


    Johannesburg, South Africa Medical Placements Full time

    Case Manager is responsible for developing and implementing intensive multifaceted risk management interventions on a patient-specific basis with the purpose of preventing or reducing the medical schemes’ exposure to potentially high cost members(in/out of hospital) who have been identified and risk stratified through claims analyses and clinical criteria....

  • Case Manager

    7 months ago


    Johannesburg, South Africa Palesa Mbali Group Full time

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  • Case Manager

    7 months ago


    Johannesburg, South Africa LetsLink Pty Ltd Full time

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    4 months ago


    Johannesburg, South Africa Medical Protection Society Full time

    Job Introduction The Member Cases and Claims Division is at the forefront of protecting the careers, reputation and financial risk of our members worldwide. The purpose of the role is to support the provision of excellent case handling services for members which is trusted and valued and provides fair treatment and outcomes. The role will do this by managing...

  • Case Manager

    7 months ago


    Johannesburg, South Africa Clinix Health Group (Pty) Ltd Full time

    To plan, coordinate and execute case management work at hospital level. The incumbent utilities clinical knowledge to minimise financial risk and ensure accurate billing through comprehensive accurate coding of patient care. **Minimum Requirements**: - Relevant Nursing qualification. - CM or Billings Clerk with ICD training and anatomy and physiology...

  • Case Manager

    4 months ago


    Johannesburg, South Africa Clinix Health Group (Pty) Ltd Full time

    **Job Summary**: To plan, coordinate and execute case management work at hospital level. The incumbent utilities clinical knowledge to minimise financial risk and ensure accurate billing through comprehensive accurate coding of patient care. **Minimum Qualifications and Experience*** - Nursing degree / diploma. - Current registration with South African...


  • Johannesburg, South Africa Aristo Sourcing Full time

    Our client is seeking a dedicated Case Manager/ Social Worker to coordinate and manage care plans for patients with chronic or complex medical conditions. This role involves working closely with healthcare providers, insurance companies, and patients to ensure optimal care and efficient use of healthcare resources. The Case Manager/ Social Worker will play a...

  • Case Manager

    6 days ago


    Johannesburg, South Africa Mass Staffing Projects Full time

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  • Rustenburg, North West, South Africa De Beers Group of Companies Full time

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  • Case Manager

    2 weeks ago


    Johannesburg, South Africa Mass Staffing Projects Full time

    Open vacancy in Gauteng! Looking for a someone that will be responsible for the liaison between the patients and managed healthcare. **Requirements**: - B Degree Nursing Qualification or equivalent NQF level 6 - Hospital case manager experience advantageous - 3 years’ experience in patient care - SAP experience preferrable

  • Case Manager

    5 days ago


    Johannesburg, South Africa Mass Staffing Projects Full time

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  • Johannesburg, South Africa Motor Industry Bargaining Council Full time

    **Duties & Responsibilities** - Monitor and account for stationery, consumable levels - Attend to professional drafted correspondence, serving and courier documents - Generate case management Reports when requested - Assist at reception(front office) or other Case Manager’ when required, - Book venues, Interpreters and Panelist for cases with proper notice...

  • Case Manager

    5 days ago


    Johannesburg, South Africa Mass Staffing Projects Full time

    **Requirements**: - Registered with the South African Nursing Council (SANC) as a Registered Nurse Degree or Diploma essential. - Minimum of 3 years in a multidisciplinary hospital environment. - Previous/current experience as a Case Manager is advantageous. - ICD-10 and CPT coding experience is essential. - A minimum of 1-2 years in computer literacy is...

  • Nurse Case Manager

    7 months ago


    Johannesburg, South Africa Talent Evolution Full time

    Nurse Case Manager provides comprehensive and professional telephonic health advisory services according to the prescribed procedures and protocols. Their duties include interacting with patients, providing health education, connecting patients with professional services and maintaining consistent communication to assess their wellbeing and make changes to...


  • Johannesburg, South Africa Rand Mutual Assurance Full time

    **THE JOB AT A GLANCE** To deliver coordinate case management: through the three pillars clinical rehabilitation, vocational rehabilitation, and social reintegration. Track progress of injured COID employees referred to RMA Rehab Team, liaise with therapy team, with the purpose of prevention of complications, and guide the process of restoration to...

  • Nurse Case Manager

    7 months ago


    Johannesburg, South Africa Talent Evolution Full time

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  • Case Manager

    5 days ago


    Johannesburg, South Africa Premier Appointments Full time

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