Case Manager
2 weeks ago
**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 registration. Proof of registration to be provide.
**Generic Objectives**:
- Compliance and Risk Management:
- Identify treatment trends and patterns to manage clinical and financial risk.
- Ensure clinical approval of authorized treatment plan.
- Ensure the cost-effective management of authorized treatment plan.
- Ensure appropriate and cost effective out of hospital care for members.
- Perform quality updates of system to ensure correct payments of treatment.
- Attend to High Level Queries and ex.
- Gratia updates
**Knowledge**
- Application of financial and risk assessment methodology
- Knowledge of scheme rules and contractual negotiations
- Application of clinical intervention principles
- Advise on best practice health risk solutions to relevant parties
**Skills**:
- Computer Technology Skills
- Task Management
- Adobe Creative Suite
- Data modelling and evaluation
- Communication Skills
- Business Writing Skills
- Ability to negotiate and influence.
- Problem solving and decision-making skills.
- Numerical Ability
- Customer Focus
- Attention to Accuracy and Detail
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