Medical Case Manager

2 weeks ago


Pretoria, Gauteng, South Africa Qetello Holdings Full time

Job Summary

Qetello Holdings is seeking a dedicated and experienced Case Manager to join their team. The ideal candidate will have a B Cur Degree / Diploma in Nursing and a minimum of 5 years of experience as a nursing practitioner.

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 hospitalized 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.

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.

Benefits:

  • 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.

About Qetello Holdings:

Qetello Holdings is a leading medical scheme based in Pretoria, dedicated to providing comprehensive healthcare benefits to its members. They are committed to innovation, quality service, and the well-being of their clients.

How to Apply:


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