Case Manager

1 week ago

Pretoria, South Africa Qetello Holdings Full time

**Functions**:

- Plan and optimise daily tasks to ensure timely updates of cases on the hospital list.
- Follow up on long-term and high-cost cases of hospitalised and home care patients.
- Identify the need for patient and hospital visits and provide documented feedback.
- Adhere to the escalation process for cases requiring input from management or the medical advisor.
- Manage telephonic calls and enquiries from clients and service providers efficiently.
- Coordinate services and care to prevent re-admissions and complications.
- Negotiate tariffs and discounts within scheme rules.
- Identify members for transfer to rehabilitation, sub-acute, and private nursing facilities for quality and cost-effective services.
- Initiate discharge planning early in hospital admission.
- Educate families about short-term medical benefits and general care exclusions.
- Communicate discharge plans and benefits to relevant parties.
- Document all communication and complete relevant information accurately.
- Communicate clinical funding recommendations to doctors, members, suppliers, and service providers.
- Identify and manage complicated and high-cost cases impacting the scheme financially.

**Skills**:

- Proficiency in MS Word, Excel, Office, Outlook, and Internet.
- Strong organisational skills with attention to detail.
- Excellent negotiation skills.
- Bilingual in English and Afrikaans with strong interpersonal communication.
- Team player with a caring attitude.
- Flexible in adapting to changes and management decisions.
- Proficient in problem-solving techniques and record keeping.
- Leadership skills and ability to maintain good interpersonal relationships.

**Requirements**:

- B Cur Degree / Diploma in Nursing.
- Minimum 5 years of experience as a nursing practitioner.
- At least 1 year of experience in the medical funding industry.
- Knowledge of ICD-10 & CPT coding, medical scheme rules, ERP, Workflow, and CAM.

**Remuneration**:

- Competitive salary commensurate with experience.
- Exceptional benefits program including 23 days of annual leave, 8-hour workday with a 30min break, life cover, disability benefits, funeral cover, pension fund, medical aid, and more.
- Office perks: free parking, Wi-Fi, landline phone allowance, on-site gym, subsidised meals, free refreshments, Athletics Club, Pilates, and wellness programs.
- Dynamic team interactions, recognition programs, and incentives.

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