Healthcare Case Coordinator

2 months ago

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

Location: Tshwane Metro, Pretoria, Brooklyn

Job Type: Permanent, Full-Time

Primary Industry: Insurance

Secondary Industry: Health, Medical and related

Key Responsibilities:
  • Organize and prioritize daily responsibilities to ensure timely updates on patient cases.
  • Monitor and follow up on long-term and high-cost cases involving hospitalized and home care patients.
  • Assess the necessity for patient and hospital visits and provide documented feedback accordingly.
  • Adhere to the escalation protocol for cases needing management or team intervention.
  • Handle incoming calls and inquiries from clients and service providers efficiently.
  • Coordinate services and care for members to mitigate re-admissions and complications.
  • Negotiate tariffs and discounts within the scheme's guidelines.
  • Identify hospitalized members suitable for transfer to rehabilitation or private nursing facilities.
  • Initiate discharge planning promptly upon hospital admission.
  • Educate families about short-term medical benefits and general care exclusions.
  • Communicate discharge plans and benefits to all relevant parties.
  • Document all communications with relevant stakeholders.
  • Compile and record all necessary information accurately.
  • Relay clinical funding recommendations through hospital authorization notes to doctors, members, and support staff.
  • Manage complex and high-cost cases that may impact the financial standing of the scheme.
Qualifications:

A completed degree or diploma as a registered nurse, with current registration with the South African Nursing Council (SANC).

Experience and Skills:
  • A minimum of four years in Managed Healthcare, preferably with oncology experience.
  • Previous experience in a similar capacity is essential.
  • Proficient in managing and prioritizing workloads effectively.
  • Strong communication and interpersonal abilities.
  • Exceptional negotiation skills.
  • Familiarity with hospital protocols and medical terminology.
Preferred Qualifications:

Additional certifications in case management or healthcare management are advantageous.

Working Environment: This role is office-based, involving regular communication with clients and healthcare providers.

Company Overview: Medihelp is a leading medical aid provider, serving over 215,000 South Africans. We seek individuals who align with our mission of promoting healthy and confident living for all stages of life.

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