Case Manager

4 weeks ago

Pretoria, South Africa H2R Full time

Gauteng, Tshwane (Pretoria)
- Monthly Cost To Company (Market related, Negotiable)

Our client, who is in the Health Care Industry, has a vacancy for a Case Manager on a Contract Basis, with a possibility of it becoming permanent

The Case Manager will have thorough, well-grounded clinical knowledge of hospital admissions, LOS and LOC

Excellent knowledge of the South African Healthcare industry and prevailing legislation, current coding structures i.e., ICD10’s,

CPT4, NRPL, PMB conditions and clinical protocols

Extensive clinical knowledge related to all aspects of patient management.

Qualifications:
Enrolled/ Registered Nurse

Valid registration with SANC

Skills and Competencies Required:
3 to 5 years’ experience within a managed healthcare or medical scheme environment

Solid understanding of value-based care

Demonstrated ability to manage a portfolio of hospital cases

Outcome focused with the ability to manage competing demands

Establishing and maintaining effective relationships with key stakeholders

Ability to accurately update and maintain cases information

Excellent telephonic and written communication skills (will be tested)

Computer literate - MIP Application System and MS Office

Reporting - MS Excel basic knowledge required (will be tested)

Proficiency in English - verbal and written

Verbal proficiency in additional languages will be advantageous

Compassionate and attentive listener - you will need to interact with the family/ loved ones of members with long-stay hospital

events

Demonstrated ability to effectively deal with emotionally charged and stressful situations

Self-motivator and the ability to work effectively in an in independent environment

Strong organisational and task prioritisation skills

Outstanding multitasking skills

Ability to research and analyse information

High degree of accuracy and attention to detail

Maintaining confidentiality of information

Knowledge of medical aid policies and procedure

Decision making skills

Following through on commitments

Flexibility to travel and a valid driver’s license

Hospital case management experience will be advantageous

Nursing experience in an ICU setting will be a big advantage

Perform Clinical coding in accordance with CPT and ICD requirements and as per client standards.

Maintaining patient’s clinical status in accordance with funder approval requirements for the duration of hospitalisation; keeping patients informed and managing the entire hospital stay’s financial risk

Provide complete and accurate updates and discharge information

Receive hospital updates and assess each case based on clinical info - allocation of appropriate Length of Stay if clinically necessary

Update Level of Care based on clinical information

Review the costs to ensure cost effective and necessary care; balance cost and effectiveness of treatment to reduce re-admission

Investigate and prepare cases for communication to the medical advisors, scheme, providers and members

Member management of hospitalised patients with Chronic conditions who are registered on the active disease management

programmes.

Facilitation of the chronic and active disease registration of hospitalised beneficiaries who are diagnosed with one or more CDL conditions

Escalation and resolution of unresolved high-cost cases

Identification and preparation of high cost / high risk incidents and reported weekly to Clinical Specialist

Discharge planning

Communication with and support to Medical Advisors

Call and written contact with Members and Providers

Contact SMS with members

Follow up on active cases with service providers relating to funding levels and updates (daily)

Interpretation of medical reports

Clinical decision making
- For more information please contact:

- Dawn Hamer

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