Registered Nurse: Case Manager

4 weeks ago


Eastern Cape, South Africa Health Solutions Full time

**Introduction**
- Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation, and create value through unique insights of how to achieve specific outcomes by using a defined set of health capabilities.**Disclaimer**
- As an applicant, please verify the legitimacy of this job advert on our company career page.**Role Purpose**
- To assist in the enhancement and management of cost-effective managed health care with the objective of promoting rational utilisation of health care facilities and containing associated costs generated by these services.**Requirements**:

- A National Senior Certificate is essential
- It is essential to have a Nursing Diploma or Degree
- Minimum of 2 years clinical experience within a private hospital is essential
- The incumbent must be registered with SANC (South African Nursing Council) as a Registered Nurse
- A certificate in ICD-10 coding is highly advantageous
- Experience in a managed care / case management environment would be an advantage
- MS Office / Office 365 proficiency

**Duties & Responsibilities**
- Review of in-hospital patients for appropriateness of care, length of stay and level of care.
- Liaise with the service provider on clinical updates, as well as outstanding information.
- Engage with the treating doctor(s) to ensure appropriate treatment, length of stay and level of care is rendered.
- Discharge planning for in-hospital patients to ensure ongoing support and care post discharge.
- Develop, implement and communicate the practice and/or clinical guidelines for cost effective care.
- Authorise appropriate and cost-effective surgical care and treatment.
- Adhere to policies and procedures and take corrective action where necessary.
- Adhere to organisational best practice and legislative requirements.
- Take ownership of escalated and unresolved queries and ensure they are resolved timeously.
- Manage queries until resolution and update the incident details.
- Identify financial and business risks to the company and escalate accordingly.
- Provide clinical support to non-clinical team’s if/when required.
- Drive and support effective teamwork within the department.
- Strive to demonstrate the company's values daily.
- Engage in hospital visits where needed to build stakeholder relationships, proactively resolve queries and increase visibility to members.
- Ensure the effective, accurate and timeous completion of relevant documentation and recording of interventions.
- Communicate with providers to improve the cost efficiencies of health care delivery.
- Ensure Service Level Agreements are met and exceeded.

**Competencies**
- Effective communication skills - verbal and written
- Accountability
- Planning and organising
- Problem solving
- Time management
- Attention to detail
- Interpersonal skills
- Customer orientation
- Results driven
- Empathetic nature
- Business Administration skills


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