Healthcare Case Coordinator
1 week ago
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.
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.
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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Healthcare Case Coordinator
1 week ago
Pretoria, Gauteng, South Africa MediHelp Full timePosition: Healthcare Case CoordinatorLocation: Tshwane Metro, Pretoria, BrooklynEmployment Type: Permanent, Full-TimeIndustry Focus: Insurance and HealthcareKey Responsibilities:Organize and streamline daily operations to ensure timely updates on patient cases within an 8-hour timeframe.Monitor long-term and high-cost cases for hospitalized and home care...
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