Case Manager: Professional Nurse MMH250416-13

1 week ago

Bellville, Western Cape, South Africa Momentum Full time R250 000 - R400 000 per year

Role Purpose

To assist in the enhancement and management of a cost-effective Managed Health Care with the objective of promoting rational utilisation of Health Care facilities and containing associated costs generated by these services.

Requirements

  • National Sernior Certificate is essential
  • Basic Diploma in Nursing (Enrolled Nurse) or Nursing Diploma or Degree - essential
  • Minimum of 3 years of clinical experience within a private hospital is essential
  • Registered with SANC (SouthAfrican Nursing Council) - essential.
  • Good understanding of the medical aid industry , competitors, and legislation - essential
  • Experience in the managed health care industry is advantageous.
  • Fully computer literate

Duties and Responsibilities

  • Arrange post-hospital care where necessary.
  • Educate and guide all members regarding health care and their benefits.
  • Develop, implement and communicate the practice and/or the clinical guidelines for cost-effective care.
  • Authorise appropriate and cost-effective surgical care and treatment.
  • Ensure the consistent and correct application of exclusions.
  • Adhere to policies and procedures and take correctiveaction where necessary.
  • Adhere to organisational best practices and legislative requirements.
  • Take ownership of escalated and unresolved queries and ensure they are resolved timeously
  • Manage the problem until resolution, updating the incident detail with any status updates.
  • Ensure the effective, accurate,and timeous completion of relevant documentation accompanying transactions.
  • Communicate with providers to improve the cost efficiencies of health care delivery.
  • Provide clear communication with regard to the outcomes and process.
  • Ensure Service Level Agreements are met and exceeded.
  • Engage in effective communication and delivery according to Service Level Agreements.
  • Adhere to all procedures and processes to improve service delivery.
  • Manage the cost of an in or out-patient episode by implementing appropriate policies and guidelines.
  • Identify financial and business risks to the company and escalate accordingly.
  • Drive and support effective teamwork within the department.
  • Engage in appropriate training interventions to promote own professional development.
  • Ensure to demonstrate the company's values on a daily basis.

As an applicant, please verify the legitimacy of this job advert on our company career page

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