Case Manager

2 weeks ago

Pretoria, Gauteng, South Africa Qetello Holdings Full time
Job Title: Case Manager

Our client, a leading medical scheme based in Pretoria, is seeking a dedicated and experienced Case Manager to join their team. As a Case Manager, you will play a crucial role in ensuring the timely and efficient management of cases, providing exceptional service to members, and contributing to the growth and success of the medical scheme.

Key Responsibilities:
  • Plan and optimize daily tasks to ensure timely updates of cases on the hospital list.
  • Follow up on long-term and high-cost cases of hospitalised and home care patients.
  • Identify the need for patient and hospital visits and provide documented feedback.
  • Adhere to the escalation process for cases requiring input from management or the medical advisor.
  • Manage telephonic calls and enquiries from clients and service providers efficiently.
  • Coordinate services and care to prevent re-admissions and complications.
  • Negotiate tariffs and discounts within scheme rules.
  • Identify members for transfer to rehabilitation, sub-acute, and private nursing facilities for quality and cost-effective services.
  • Initiate discharge planning early in hospital admission.
  • Educate families about short-term medical benefits and general care exclusions.
  • Communicate discharge plans and benefits to relevant parties.
  • Document all communication and complete relevant information accurately.
  • Communicate clinical funding recommendations to doctors, members, suppliers, and service providers.
  • Identify and manage complicated and high-cost cases impacting the scheme financially.
Requirements:
  • B Cur Degree / Diploma in Nursing.
  • Minimum 5 years of experience as a nursing practitioner.
  • At least 1 year of experience in the medical funding industry.
  • Knowledge of ICD-10 & CPT coding, medical scheme rules, ERP, Workflow, and CAM.
What We Offer:
  • Competitive salary commensurate with experience.
  • Exceptional benefits program including 23 days of annual leave, 8-hour workday with a 30min break, life cover, disability benefits, funeral cover, pension fund, medical aid, and more.
  • Office perks: free parking, Wi-Fi, landline phone allowance, on-site gym, subsidised meals, free refreshments, Athletics Club, Pilates, and wellness programs.
  • Dynamic team interactions, recognition programs, and incentives.

Join our client and be part of a team that values innovation, quality service, and the well-being of its members. Apply today to contribute to a leading medical scheme's success and make a difference in the lives of many.

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