Hospital Case Manager
6 months ago
**Company Description** About Kaelo**
Kaelo provides essential healthcare solutions ensuring the physical and psychosocial well-being of all South Africans towards lasting social change.
Insurance products with limited medical benefit need close supervision for casualty and admission cases.
Load all hospital related cases for casualty treatment and admission into hospital.
Communicate with the clients on the benefit availability and limitation.
Review the correct level of care for admitted clients.
Negotiate with Health Care providers for clinical information.
Discharge planning for admitted patients.
This position reports to the Health Operations Manager. This position’s functions are supervised by the clinical service manager.
**Key Outcomes**
Responsibilities include:
- Ensuring service level agreements are met.
- Answering calls routed through for casualty or hospital treatment and admission.
- Identify exclusions from the onset of request for treatment.
- Ensure that correct benefit is utilised by member.
- Correct level of care is allocated to the correct facility.
- Latest medical guidelines are used within the available benefit.
- Reporting on cases actioned per month including savings.
- Report any clinical escalations/concerns to the clinical Review team.
- Act as a patient advocate
- Maintain all the confidentiality in clinical conditions shared with her/him.
- Review latest appliances used in hospital against the current treatment guidelines.
- Educate patients on benefit and limitations on their insurance option.
- Developing referral and treatment protocols for new or updated conditions identified.
- Discussing diagnosis with doctors, specialists and other health care providers,
- Conducting assessments of patient needs, such as mental health issues or substance abuse problems and refer to EAP where applicable.
- Providing information about treatment options, side effects, and possible complications of medications or procedures
- Assisting with monthly reporting on statistics
- Utilize all resources and guidelines at his/her disposal to effectively assess, prioritize, advise, and manage patients admitted.- Thoroughly complete documentation utilizing the appropriate computer software in compliance with the approved policies and procedures.
- Maintain current nursing skills and knowledge base by attendance at workshops and seminars, completion of mandatory continuing education, reading of professional journals, publications, and participation in professional organizations.
**Qualifications** Qualifications**
Required
- Registered Nurse
- Degree /Diploma in Nursing
- ICU/Operation theatre trained, or experience is an advantage.
- 2 years hospital Case Management experience would be beneficial.
- Medical Aid or Insurance industry experience will be an advantage.
- Sound knowledge of ICD and CPT coding and DRG’s
Preferred
- Professional Nurse with SANC registration
- Prefer minimum of three years recent clinical experience in health, critical care and/or emergency room.
- Familiarity/experience with patient interactions on the telephone
- Strong communication and interpersonal skills
**Technical Skills or Knowledge**
- Attention to detail.
- Health risk assessment knowledge
- Computer Literacy
**Knowledge and Abilities**
- An ability to establish and maintain effective working relationships with patients, physicians, co-workers, staff and medical service providers.
- Strong ability to communicate effectively both verbally and in writing; thoughts are logical and clearly expressed.
- Excellent organizational abilities and documentation skills.
- Must be able to work well under stress and relate to the general public, nurses and physicians in a tactful manner.
- Must have adequate typing skills and basic computer knowledge.
**Additional Information**
**PERSONAL ATTRIBUTES: COMPETENCIES**
- Accountability
- Communication
- Business writing skills
- Efficient and effective mindset
- Planning and organisation
- Resilient and adaptive
- Self-development
- Significance and values orientated.
- Ethical
-
Case Manager in Hospital
6 months ago
Johannesburg, South Africa Palesa Mbali Group Full time**Position**: Case Manager In Hospital **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...
-
Hospital Case Manager
6 months ago
Johannesburg, South Africa Kaelo Full timeCompany Description **About Kaelo** Kaelo provides essential healthcare solutions ensuring the physical and psychosocial well-being of all South Africans towards lasting social change. Insurance products with limited medical benefit need close supervision for casualty and admission cases. **Job Description**: Load all hospital related cases for casualty...
-
Hospital Case Manager- Kzn
7 months ago
Johannesburg, South Africa Medical Placements Full timeThe Case Manager is responsible to act as the liaison and care co-ordinator between the patient and various healthcare providers, including physicians, nurses, therapists, social workers, other specialists, family members and the funders to ensure high-quality care and rehabilitation services that supports person-centred health and care, promoting positive...
-
Case Manager
7 months ago
Johannesburg, South Africa LetsLink Pty Ltd Full timeRole Title: Case Manager Role Summary: Are you a healthcare professional looking to make a significant impact in patient care and financial risk management? If so, we have an exciting opportunity for you to join the team of a private hospital based in Gauteng as a Case Manager. In this role, you will leverage your clinical knowledge and expertise to ensure...
-
Case Manager
7 months ago
Johannesburg, South Africa Mass Staffing Projects Full time**Job Information** - Location- Johannesburg- Salary- R400k-R300k- Job Type- Permanent- Education- Degree/Diploma in Nursing- Experience- +2 years’ experience in case management- - pharmacy.jobs(at)staffingprojects.co.za- Fax- 0866023398This just in! A vacancy for a case manager at a private hospital in Johannesburg is currently...
-
Case Manager
6 months ago
Johannesburg, South Africa Clinix Health Group (Pty) Ltd Full timeTo 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
1 week ago
Johannesburg, South Africa Glasshouse Recruiting Full timeThe Case Manager will be the liaison between the patient and medical aids in order to secure payment for the hospital **Inherent Requirements**: - B Degree Nursing qualification or equivalent NQF level 6 - 3 years patient care experience - Previous ICU / HC case management experience will be advantage - Understanding of clinical coding, funder rules...
-
Case Manager
6 months ago
Johannesburg, South Africa Palesa Mbali Group Full time**Case Manager** **Position**: Case Manager **Department**: General and Specialized Case Management **Grade**: B4M1 **Position Purpose**: **Experience**: 5 years ward experience, 2 years’ experience hospital scheme case management advantageous **Qualifications**: Degree / Diploma in nursing, midwifery, and psychiatry. Current SANC professional nursing...
-
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...
-
Case Manager
7 months ago
Johannesburg, South Africa Medical Placements Full timeCase 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
4 days ago
Johannesburg, South Africa Mass Staffing Projects Full timeOpen 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
-
Quality Control Case Manager
7 months ago
Johannesburg, South Africa Mass Staffing Projects Full time**Job Information** - Location- Johannesburg- Salary- R500k-R400k- Job Type- Permanent- Education- Degree/Diploma in Nursing- Experience- +3 years case management experience- - pharmacy.jobs(at)staffingprojects.co.za- Fax- 0866023398Are you looking for a career growth? Then this is for you! A vacancy for a Quality Control Case Manager at a private hospital...
-
Case Manager
6 months ago
Johannesburg, South Africa Palesa Mbali Group Full time**Key Activities** - Identify treatment trends and patterns to manage clinical and financial risk - Defined legal, statutory, and regulatory compliance is maintained at the required standards - Operational risk and governance structures, measures and frameworks are complied with and necessary action is taken to address issues, when necessary - Ensure...
-
Rehabilitation Case Manager
7 months ago
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...
-
Clinical Case Consultant
7 months ago
Johannesburg, South Africa Kaelo Full timeCompany Description Kaelo provides **essential healthcare solutions** ensuring the **physical and psychosocial wellbeing** of **all South Africans** towards **lasting social change**. **Job Description**: The Clinical Case Consultant provides quality patient management to clients that have chronic disease of lifestyle conditions. They are responsible for...
-
Case Management Officer
7 months ago
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...
-
Litigation Case Manager
7 months ago
Johannesburg, South Africa AristoSourcing Inc. Full timeAristoSourcing LLC is an Outsourcing company highly focused on the Digital Marketing Industry. Our company has been in the industry for more than 7 years. We hired and referred skilled and experienced Virtual Assistants to work and collaborate directly with our respective clients from different parts of the globe that offer 100% remote work for talented and...
-
Clinical Case Manager
3 months ago
Johannesburg, South Africa MHR Full time**Job Advert Summary**: Our client, a leader in the private healthcare industry, is urgently looking for an experienced **Case Manager** for a** **permanent opportunity** **at a private** Emergency Services Contact Centre** in **Rivonia (Johannesburg)**. **BENEFITS** - Pension fund membership and subsidy from the company - Medical aid membership and subsidy...
-
Team Leader
6 months ago
Johannesburg, South Africa Edge Executive Search Full timeYour role will be critical in optimising patient care and ensuring efficient resource allocation. **Experience**: - A minimum of 5 years of general medical and surgical nursing experience in the private sector. - ICU training and/or at least 1 year of ICU nursing experience. - At least 1 year of hospital case management experience will be...
-
Case Manager
4 months ago
Johannesburg, South Africa Medical Protection Society Full timeJob 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...