Pensions Medical Case Auditor

**THE JOB AT A GLANCE**

As the Pensions Medical Case Auditor (PMCA), you will be responsible for effectively and efficiently rendering medical support to internal and external stakeholders.

**WHAT WILL YOU DO?**
- Monitoring of Hospital Admissions weekly and liaison with Case Managers.
- Give feedback to Case Managers and other Colleagues of Pensioners admitted in Hospitals and include for hospital utilisation management.
- Authorization of Pensioners Hospital admissions, Chronic Medications and Sundries, prosthetic repairs and replacement
- Adjudicate requests for subsequent care and refer to RMA doctor as necessary.
- Assess and adjudicate medical service provider reports and advise on invoices submitted and captured when requested.
- Visit medical service providers and hospitals to address Pensioners related issues
- Organize and attend scheduled clinics.
- Organize transport for SCI acute admissions, uro reviews and taxi fares for prosthetic pensioners.
- Visit existing high risk/cost and new DRG 1 pensioners as per PMP schedule.
- Organizing uro reviews and capture the uro report.
- Organize prosthetic review clinic and load report on CC2.
- Assist to obtain death certificate and Notification of Death (if available) for deceased pensioners and autopsy reports if available.
- Assist with medical walk-in office clients.
- Capture Medical Reports via scanning in respect of pensioners, chronic medication, and subsequent care and specific medical reports requested.
- Assist with education of pensioners on entitlements.
- Updating DOCR with hospital pensioner admissions and discharges for DRG 1 to 3.
- Weekly/Monthly report of Pensioner URO reviews, home visits and prosthetic reviews and other interventions.
- Manage visa and passport expiry documents of SCI pensioners in Hospital.
- Managing and control of medical expenses as per yearly plan
- Follow up, from RMA system generated reports, high cost claims based on type of injury and estimated costs.

**WHAT YOU'LL BRING TO THE TABLE?**
- Nursing diploma /degree
- 3 years nursing experience as professional nurse
- Valid Driver’s License
- Registration with Nursing Council or relevant Health Professional Council
- Building Customer Loyalty
- Contributing to Team Success
- Managing Work (includes Time Management)
- Stress Tolerance
- Decision Making
- Confidentiality
- Credibility
- Friendly
- Initiative
- Integrity

**WHAT WILL YOU GET IN RETURN?**

This is an exciting opportunity within the Rand Mutual Assurance team, offering exposure to an interesting combination of technical and business issues. This is a great time to join RMA as we look to grow the Life business and develop our actuarial team.

We offer great opportunities for personal and professional development in a stable company that’s 128 years strong. The role comes with a competitive salary package and various benefits. Flexible work arrangements (combination of remote and in the office). Furthermore, you will be a part of a dedicated group of colleagues who value teamwork and collaboration.

**Turnaround time**

**Closing date: 04 April 2024**

**Our Commitment to transformation**:

- Nursing diploma /degree
- 3 years nursing experience as professional nurse
- Valid Driver’s License
- Registration with Nursing Council or relevant Health Professional Council
- Attention to detail
- Building Customer Loyalty
- Contributing to Team Success
- Managing Work (includes Time Management)
- Stress Tolerance
- Decision Making
- Confidentiality
- Credibility
- Friendly
- Initiative
- Integrity