Clinical Case Manager

4 days ago


Pretoria, Gauteng, South Africa H2R Africa Full time
{"title": "Case Manager", "description": "Job Summary

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.
Requirements
  • 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.
Skills
  • 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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