Mva Field Case Manager

3 weeks ago


Sandton, South Africa Clinix Health Group (Pty) Ltd Full time

To plan, coordinate and execute case management work for RAF Business in the CHG Facilities. The incumbent utilises clinical and RAF knowledge in managing RAF Business in the facilities to minimise financial risk and ensure accurate billing through comprehensive accurate coding and classification of RAF available products offered in the facilities, Authorization of these products to ensure that they will be fully reimbursed.

**Minimum Requirements**:

- Diploma/ Degree in General Nursing or Business-Related qualification.
- 3-5 years’ experience as RAF Case manager/Claims Adjudication Unit.
- Knowledge of ICD-10 and CPT coding.
- Knowledge of RAF Industry

**Minimum work experience**:

- To collaborate with the fund in ensuring that the patient/claimant have access to quality healthcare services from both Acute and Rehabilitation to achieve good clinical outcomes and reintegration back to the society.
- To establish a framework in enhancing service delivery to patients with due attention to the Fund's financial obligation and payment processes.
- Conduct site case management through visits to different CHG facilities and Government facilities where CHG has signed MOA with and share clinical updates with the fund.
- Obtaining approval of care based on the Fund's treatment protocols and an appropriate referral system for specialized management.
- Establish working groups with sufficient representation from the Fund and facilities to enable good clinical governance.
- Consult daily with all relevant health care providers with regards to patient treatment.
- Investigate and understand Funder, Doctors, Nurses and Patient needs to enable delivery of a quality service
- Ensure service knowledge and advice is technically accurate and provide stakeholders with relevant information to keep them informed of products and service options.
- Ensure conflict resolution and respond to any complaints or concern.
- Ensure complete, timeous and accurate reporting with appropriate levels of escalation to enable effective decision-making.


  • Case Manager

    2 days ago


    Sandton, South Africa Watershed Consulting Full time

    Registered Nurse with case management experienced needed in the insurance sector! **Scope of Responsibility**: - Overall responsibility for incoming calls from Hospitals Case Managers relating to authorisations for procedures in Hospitals, Casualty, Specialist, GP, or Dental provider rooms. - Hospital case management from issuing a guarantee of payment...


  • Sandton, South Africa Discovery Ltd. Full time

    **Business Unit**:Discovery Life**Function**:Case Management**Date**:2 Oct 2024- Discovery - Discovery Life Case Management Consultant**About Discovery** - Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own...


  • Sandton, South Africa IDC Full time

    **Job Description** JOB PURPOSE**: Project preparation specialists who work hand-in-hand with Sponsors to fully prepare their Early Business Cases and Intermediate Business Cases, engaging with the Infrastructure Fund and other role players to access specialist advisory services for social and economic infrastructure projects. **Qualification and...


  • Sandton, South Africa FirstRand Full time

    About us, purpose, experience and qualifications **about us**: - make a promise - be deeply invested - value our differences - build trust, not territory - have courage - always do the right thing **purpose**: - To provide end to end customers service and resolution as named case manager in achievement and enhancement of the group Customer Service...

  • Oncology Case Manager

    4 months ago


    Sandton, South Africa Discovery Ltd. Full time

    **Business Unit**:Discovery Health**Function**:Client Service**Date**:10 Sep 2024**About Discovery** Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced...


  • Sandton, South Africa SYSPRO Full time

    **Description**: The Field Validation Manager is responsible for maintaining the organization's effective product delivery by defining and delivering real world product field validation projects on product prior to release and the review of existing solutions in the field. **Key Responsibilities**: - To facilitate the creation of production monitoring from...


  • Sandton, South Africa Field and Insights Africa Full time

    **Employment Type**: 6 Months Fixed Contract **Location**: Bryanston **Department**: Field Operations **Job Title**: Internal Data Collector (CATI and CAPI) **Reports to**: CATI Manager Duties and responsibilities Approach and convince strangers to take part in market research interviews. Contact the general public by telephone to conduct interviews for...

  • Field Merchandiser

    7 months ago


    Sandton, South Africa MVC Marketing Full time

    MVC Marketing is seeking a vibrant and hardworking individual to join our dynamic team as a Field Merchandiser in JHB North. Applicants must be able to work independently and integrate well into a team. - **Job Description**_**: - Call on a database of stores in the area, - Managing allocated store database in the area, - Merchandise products in store, -...


  • Sandton, South Africa vivo Full time

    1.Field Team & Channel Sales Extraction - Extracting data from the sales system, cleaning and organizing data into the sales report for a month-to-month comparison. - Integrating cleaned data into PPT format. - Providing sales insights of each departments sales coverage through a sales report comparisons. 2.Collection of Regional sales data. - Collecting...


  • Sandton, South Africa Profile Personnel Full time

    Group Aftersales Field Operations ManagerThe future of mobility is changing. What do we contribute to this? Volkswagen produces vehicles in 14 countries and delivers them to customers in more than 150 markets worldwide. Electromobility, smart mobility and digital transformation are our core topics for the future. For many millions of people, The company is...


  • Sandton, South Africa FirstRand Full time

    About us, purpose, experience and qualifications **about us**: - make a promise - be deeply invested - value our differences - build trust, not territory - have courage - always do the right thing **purpose**: - Develop and implement fraud detection and prevention strategies and practices by using fraud trend insights within the fraud community to...


  • Sandton, South Africa SNG GrantThornton Full time

    **PURPOSE**: To effectively manage and support the team in both Jersey and Guernsey, ensuring the team is motivated to perform and committed to effective client service and that the quality of work meets the company’s ethical and professional standards and supports organisational success. The Manager will supervise and coach staff in the R&R department...


  • Sandton, South Africa Jobted ZA C2 Full time

    Empower Solutions Onsite! Join Us as a Field Support Engineer. As a Field Support Engineer, you'll troubleshoot, maintain, and optimize systems while building trust and relationships face-to-face. If you thrive in dynamic environments, enjoy problem-solving, and love making a tangible impact, this is your opportunity to shine!  What you’ll...


  • Sandton, South Africa IOCO Full time

    Empower Solutions Onsite! Join Us as a Field Support Engineer. As a  Field Support Engineer,   you'll troubleshoot, maintain, and optimize systems while building trust and relationships face-to-face. If you thrive in dynamic environments, enjoy problem-solving, and love making a tangible impact, this is your opportunity to shine!   What...


  • Sandton, South Africa Absa Bank Limited Full time

    Empowering Africa’s tomorrow, together one story at a time. - With over 100 years of rich history and strongly positioned as a local bank with regional and international expertise, a career with our family offers the opportunity to be part of this exciting growth journey, to reset our future and shape our destiny as a proudly African group.Job Summary Are...


  • Sandton, South Africa Profile Personnel Full time

    Job DescriptionWe are seeking a highly skilled Senior Sales and Marketing Manager to lead our Group After-Sales Field Operations team in the South African and Sub-Saharan Region.This is a senior management role responsible for driving business growth, improving customer satisfaction, and optimizing sales performance. The successful candidate will have a deep...


  • Sandton, South Africa Absa Bank Limited Full time

    Empowering Africa’s tomorrow, together one story at a time. - With over 100 years of rich history and strongly positioned as a local bank with regional and international expertise, a career with our family offers the opportunity to be part of this exciting growth journey, to reset our future and shape our destiny as a proudly African group.Job Summary As...

  • Field Support Engineer

    5 months ago


    Sandton, South Africa IOCO Full time

    Join the iOCO Infrastructure Services Community: Where Work is an Adventure, Not Just a Job. We are seeking a Field Support Engineer who will provide on-site support for various systems, equipment, or software, ensuring that clients' technology operates smoothly and efficiently.    What you’ll do: Experience in mobile device support...

  • Field Support Engineer

    5 months ago


    Sandton, South Africa IOCO Full time

    Join the iOCO Infrastructure Services Community: Where Work is an Adventure, Not Just a Job.We are seeking a Field Support Engineer who will provide on-site support for various systems, equipment, or software, ensuring that clients' technology operates smoothly and efficiently.  What you’ll do:Experience in mobile device supportResponsible for...


  • Sandton, South Africa JSE Limited Full time

    Manager – Equities and Equity Derivatives Listing reference: jse_000537 Listing status: Online Apply by: 10 September 2024 Position summary Job category: Banking, Finance, Insurance. Stockbroking Contract: Permanent Remuneration: Market Related EE position: Yes About our company The JSE recognises that its success and strength depend on the...