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Case Manager in Hospital
7 months ago
**Position**:
Case Manager In Hospital
**Department**:
Managed Care
**Grade**:
B4M1
**Position Purpose**:
To coordinate care in allocated facilities, in order to improve health outcomes and manage the cost to the Scheme(/s). The case manager's responsibilities start from patient admission to discharge and they should have an understanding of hospital processes and the importance of making cost-effective decisions. To manage the Scheme risk by doing patient verification, assessing the quality of information received and obtaining the required clinical information to make a funding decision in line with Scheme rules and Standard Operating Procedures. This role is central to utilization review, evaluating healthcare treatments and negotiating the most cost effective options available but at the same time adhering to ethical and legal standards.
**Experience**:
A minimum of 2 years’ of Case management experience (private sector). At least 5 years medical and surgical ward experience,
at least 2 year experience in ICU or high care.
Computer literacy (Outlook, Word, Excel)
Code 08 driver’s license, own transport essential, extensive travelling
Willing to work outside of normal office hours from time to time
**Qualifications**:
Registered Nurse, Professional Membership
**Knowledge**
- Application of financial and risk assessment methodology
- Knowledge of scheme rules and contractual negotiations
- Application of clinical intervention principles
- Advise on best practice health risk solutions to relevant parties
