Healthcare Case Coordinator

1 week 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 activities to ensure timely updates on patient cases within the required turnaround time.
  • Monitor and follow up on long-term and high-cost cases for both hospitalized and home care patients.
  • Assess the necessity for patient and hospital visits, providing documented feedback when applicable.
  • 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 minimize readmissions and complications.
  • Negotiate tariffs and discounts in accordance with scheme regulations.
  • Identify hospitalized members suitable for transfer to rehabilitation or private nursing facilities.
  • Commence discharge planning early during hospital admissions.
  • 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.
  • Complete and maintain all necessary documentation.
  • Convey clinical funding recommendations through hospital authorization notes to doctors, members, and support staff.
  • Identify and manage complex and high-cost cases that could impact the financial standing of the scheme.
Qualifications Required:

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

Experience, Knowledge, and Skills:
  • A minimum of four years in Managed Healthcare, particularly in oncology or a related unit.
  • Previous experience in a similar capacity.
  • Proficient in managing and prioritizing workload effectively.
  • Strong communication and interpersonal abilities.
  • Exceptional negotiation skills.
  • Familiarity with hospital procedures and medical terminology.
Preferred Qualifications:

Additional certifications in case management or healthcare management are advantageous.

Working Environment: This role involves an office setting, with regular interactions through phone calls 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 fostering healthy, confident South Africans at every life stage.



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