Case Manager

1 week ago


Pretoria, Gauteng, South Africa MediHelp Full time
Job Title: Case Manager - Medical Aid

MediHelp is seeking a skilled Case Manager to join our team in Tshwane Metro, Pretoria, Brooklyn. As a Case Manager, you will play a crucial role in ensuring that our members receive the best possible care and support.

Key Responsibilities:
  • Plan and optimize daily tasks to update cases on the hospital list within the 8-hour turnaround time
  • Follow up on long-term and high-cost cases of hospitalised and home care patients
  • Identify the need for patient and hospital visits where possible and provide documented feedback
  • Escalate cases that require input from management or the team
  • Manage telephonic calls and inquiries from clients and service providers
  • Coordinate services and care for members to prevent re-admissions and complications
  • Negotiate within scheme rules regarding tariffs and discounts
  • Identify hospitalised members for transfer to rehabilitation sub-acute and private nursing facilities
  • Initiate discharge planning early in hospital admission
  • Inform family regarding short-term medical benefits and educate them regarding general care exclusions
  • Communicate with relevant parties about the discharge plan and benefits
  • Document all calls made to relevant parties
  • Complete and document all relevant information
  • Communicate clinical funding recommendations via hospital authorisation notes to doctors, members, and support staff
  • Identify and manage complicated and high-cost cases that have a financial impact on the scheme
Requirements:

A completed degree or diploma as a registered nurse

Registration with the South African Nursing Council (SANC)

Preferred Qualifications:

Additional certifications in case management or healthcare management

Working Conditions: The role involves working in an office setting, handling calls and interacting with clients and healthcare providers on a regular basis.

Company Branding: We welcome employees who share our vision of shaping healthy, confident South Africans making the most of every life stage.


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