Clinical Case Manager
4 days ago
We are seeking a skilled Case Manager to join our dynamic team at H2R Africa. As a Case Manager, you will be responsible for managing the clinical appropriateness and risk of hospital events and associated healthcare services.
Key Responsibilities- Perform clinical coding in accordance with CPT and ICD requirements.
- Maintain patients' clinical status in accordance with funder approval requirements.
- Provide complete and accurate updates and discharge information.
- Review costs to ensure cost-effective and necessary care.
- Investigate and prepare cases for communication to medical advisors, schemes, providers, and members.
- Manage hospitalised patients with chronic conditions.
- Facilitate chronic and active disease registration of hospitalised beneficiaries.
- Escalate and resolve unresolved high-cost cases.
- Identify and prepare high-cost/high-risk incidents.
- Discharge planning.
- Communication with medical advisors.
- Call and written contact with members and providers.
- Enrolled/Registered Nurse.
- Valid registration with SANC.
- 3 to 5 years experience within a managed healthcare or medical scheme environment.
- Valid drivers' license and own vehicle.
- Thorough clinical knowledge of hospital admissions, LOS, and LOC.
- Excellent knowledge of the South African Healthcare industry and prevailing legislation.
- Extensive clinical knowledge related to patient management.
- Solid understanding of value-based care.
- Outcome-focused with ability to manage competing demands.
- Establishing and maintaining effective relationships with stakeholders.
- Excellent telephonic and written communication skills.
- Computer literate - MIP Application System and MS Office.
- Reporting MS Excel basic knowledge required.
- Proficiency in English verbal and written.
- Verbal proficiency in additional languages advantageous.
- Compassionate and attentive listener.
- Demonstrated ability to effectively deal with emotionally charged situations.
- Self-motivator and ability to work independently.
- Strong organisational and task prioritisation skills.
- Outstanding multitasking skills.
- Ability to research and analyse information.
- High degree of accuracy and attention to detail.
- Maintaining confidentiality of information.
- Knowledge of medical aid policies and procedures.
- Decision making skills.
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Pretoria, Gauteng, South Africa H2R Africa Full time{"title": "Case Manager", "description": "Job SummaryWe are seeking a skilled Case Manager to join our dynamic team at H2R Africa. As a Case Manager, you will play a critical role in managing the clinical appropriateness and risk of hospital events and associated healthcare services.Key ResponsibilitiesPerform clinical coding in accordance with CPT and ICD...
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