Case Management Lead

14 hours ago

Johannesburg, South Africa Complement Recruitment Full time

Complement Recruitment are recruiting for a Case Management Lead for a permanent position based in Sandton, Johannesburg, Gauteng. Our client is looking for an experienced, commercially minded and operationally strong case management lead with a proven track record of implementing and streamlining projects and making sure they have high impact for the business and the care of our Consumers (Patients). Ideally someone sees a discrepancy or concern and takes the initiative and responsibility to immediately raise it and be able to come up with proposed actions. As Case Management Lead, you would form an integral part of the journey by facilitating the reimbursement process and using the available resources to promote Consumer quality of care, and the best possible funding outcomes.

**Minimum Requirements**:

- High school diploma or equivalent required;
- Minimum Education of Bachelor’s Degree;
- Minimum 2 years’ experience in a medical / healthcare; funding or managed care related environment.
- Relevant experience in case management with a key understanding of the funder landscape within South Africa is crucial.
- 2 years team lead experience is advantageous

**Knowledge, Skills And Abilities**
- Thorough knowledge of case management principles, healthcare management and ICD coding knowledge;
- A comprehensive understanding of the Medical Schemes Act and regulations;
- Set knowledge and expertise when it comes to PMB (Prescribed Minimum Benefit) conditions and PMB level of Care;
- Strong business acumen and commercial understanding;
- Strong written and verbal communication skills; reporting skills;
- A deep passion for customer service and an understanding of customer behaviour;
- Ability to convey medical terms and treatment plans so they are understood by Consumers;
- Excellent organisational and time management skills;
- Astute problem-solving skills with the ability to multi-task;
- Compassionate and empathetic demeanour for Consumers with the ability to work both independently and in a group/team environment;
- Excellent numerical skills and the ability to construct fact-based recommendations and business cases

**Personal Attributes**
- Strong passion for making life easier for people with intimate healthcare needs;
- Strong alignment with Company Vision, Mission and values;
- Quick learner, intellectual capacity with a high degree of common sense, resourcefulness, and flexibility;
- Organized and highly structured with the ability to successfully lead multiple projects and manage deadlines as well as handle ambiguity;
- Should have excellent communication and decision-making skills, as well as experience working closely with people;
- Ability to balance needed attention to detail with a pragmatic view on opportunity, impact and feasibility;
- Growth mind-set;
- Strong communication skills face to face and over the phone and ability to interact with different cultures in South Africa

**Duties**:
**Consumer Advocacy**
- Work cross-functionally to ensure smooth end-to-end authorization for Portfolio Consumers that delivers an optimal experience;
- Create and maintain a clear set of guidelines that educates Consumers on their condition, their funding options and their Medical Scheme benefit limit and rules.
- Help Consumers navigate our local health reimbursement system and own their relationship with the Medical Schemes by connecting them with the correct departments within medical schemes.
- Provide guidance on early case strategy and the appropriate pathway for future management i.e., settlement or investigation.

**Relationship building with internal and external stakeholders**
- Own and create the relationship with Medical Aid Schemes in South Africa together with Market Access to ensure close collaboration for improved patient outcomes.
- Acting as a technical expert for the team, by reviewing and dealing with complex, challenging and sensitive case management issues when it comes to Consumers’ needs.

**People Leadership**
- Live our leadership principles and proactively manage the team of Case Management Specialists and their KPIs
- Coaching and training of the team and ensuring new processes are implemented effectively

**Reporting and Tracking**
- Lead the case management processes by using a continuous improvement mindset (identify need for change, plan, implement and test).
- Implement Case Management controls for tracking and feedback to our Consumers and our internal team.
- Agree to clear KPI’s, and drive performance management against those KPIs.

**Forward Thinking And Innovation**
- Monitoring and gaining an understanding of the evolution of medical aid plans and collaborating with key stakeholders in the financial management of treatments;
- Mitigation of risks related to health spend.
- Review Treatment plans on a case by case basis, within the bounds of protocols and guidelines;

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