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Company Overview
">Kaelo is a leading provider of essential healthcare solutions in South Africa, dedicated to ensuring the physical and psychosocial well-being of all individuals. With a focus on corporate and retail clients, Kaelo offers a range of services including medical insurance, medical aid, gap insurance, and employee assistance programs.
">Job Description
">- Hospital Care Coordinators play a critical role in overseeing the end-to-end management of in-hospital cases for Kaelo clients.
- Their responsibilities include coordinating care from admission to discharge, ensuring optimal care delivery at the most effective price point, and communicating with patients and providers about benefit availability and limitations.
Key Responsibilities
">- Receive handover on cases admitted/authorised by the Acute Care Coordinators.
- Coordinate care for all hospital admitted patients.
- Ensure that correct benefit is utilised by member.
- Identify exclusions from the onset of request for treatment.
- Ensure that the correct level of care is allocated to the correct facility.
- Review appliances used in hospital against the current treatment guidelines.
- Provide information about treatment options, side effects, and possible complications of medications or procedures.
- Discussing diagnosis with doctors, specialists and other health care providers.
- Conducting assessments of patient needs, such as mental health issues or substance abuse problems and refer to EAP where applicable.
- Ensure service level agreements are met.
- Use the latest available evidence-based guidelines for patient management.
- Develop referral and treatment protocols for new or updated conditions identified.
- Report any clinical escalations/concerns to the Clinical Review Committee.
- Act as a patient advocate.
- Maintain confidentiality in clinical conditions shared with her/him.
- Assisting with monthly reporting: statistics, savings for example.
Qualifications and Experience
">- Registered Nurse
- Degree/Diploma in Nursing
- ICU/Theatre trained.
- Minimum 2 years Hospital Case Management experience.
- Medical Aid or Insurance industry experience and knowledge.
- Sound knowledge of ICD and CPT coding and DRGs.
Requirements
">- Proven experience in a managed healthcare setting with hospital case management.
- Strong understanding of healthcare regulations and accreditation standards.
- Excellent analytical, problem-solving, and critical thinking skills.
- Excellent clinical acumen and confidence in clinical decision making.
- Ability to communicate confidently with multidisciplinary healthcare professionals.
Professional Attributes
">- Accountability for clinical decisions made.
- Communication with all related health care workers, patients and next of kin as needed.
- Writing skills for clear and concise notes that are easy to understand.
- Efficient and effective mindset to make clear clinical decisions without prejudice and interfering personal beliefs.
- Planning and organisation of work to be of great standards.
- Resilient and adaptive to different environments.
- Propensity for self-development.
- Ethical, always maintaining professional image and language.
Seniority Level
">Mid-Senior level
">Employment Type
">Full-time
">Industry
">Insurance
