Senior Officer: Field Case Management x2

1 month ago

Cape Town, South Africa Road Accident Fund Full time
Job Title: Senior Officer: Field Case Management X2

The Road Accident Fund’s mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.

 

 

 

Note: This is a 6 Months Fixed Term Contract

 

Purpose of the Job:  To manage the rehabilitation and health care needs of the injured.

 

Key Performance Areas

 

Decision making regarding quality of care.

 

  • Assessment of ongoing medical problems of the injured after discharge in the home environment.
  • Assessment of patient according to prescribed measurements.
  • Assessment of burden of care and needs of the client.
  • Monitors of quality of care issues
  • Selection and monitoring clinical pathways.

 

Decision Making regarding collaboration.

 

  • Facilitates collaboration of service providers with client.
  • Protector of privacy and confidentiality.
  • Coordination of plan of care and services.
  • Facilitate caregiver’s appointments necessary for the client.
  • Facilitate timely consultation with appropriate medical service providers.
  • Facilitate family and clinical team communication.
  • Health educator and counsellor for client and family.
  • Utilization review.
  • Post discharge follow-through.

 

Decision making regarding advocacy criteria.

 

  • Conflict resolution expert and referee.
  • Liaison between patient and care team.
  • Negotiating and procuring resources and services from providers.
  • Benefit analysis.
  • Record keeping and documentation.
  • Maintain patient confidentiality.

 

Decision making regarding resource utilization.

 

  • Post discharge follow-through.
  • Drug utilization review.
  • Assistive devices necessary for client.
  • Home alterations.
  • Vehicle adaptations.
  • Vocational guidance after life changing event for client.
  • Placement of children in special schools.
  • Back to work opportunities.

 

Decision making regarding legal & ethical criteria.

 

  • Advise client of accident relatedness of his claim.
  • Decide reasonableness and appropriateness of service.
  • Advise whether altering homes and placing clients in rehab centres or institutions is appropriate.
  • Advice regarding payment of care givers taking into account patient autonomy, informed choice, medical implications and burden of care.

 

Pre-authorisation of admissions.

 

  • Arrange for hospital admission and advise patients on their benefit.

 

Assess medical Bills.

 

  • Assessment of bills received and advise claimants of outcomes of bill review.

 

Recommend payment.

 

  • Recommend payment of bills assessed.

 

Qualifications

 

  • Bachelor’s degree or Advanced Diploma in Nursing/ Allied Health Professions or related qualification.
  • Registration with the relevant Health professions council.
  • Knowledge of ICD and CPT coding will be an advantage.
  • Valid code 8 driving license.

 

Experience

 

  • Relevant 4 years’ experience in the medical field of which 1 year is on supervisory level.
  • Experience in Managed health.

 

Competencies

 

Behavioural.

 

  •  Organisational Resilience.
  • Team Resilience.
  • Network and Alliances
  • Personal Mastery.
  • Judgement and Decision Making.
  • Emotional wisdom
  • Ethics and Governance.
  • Customer orientation and Customer Focus.

 

 

Technical.

 

  • People orientated.
  • Team player.
  • Adaptability, flexibility, and creativity.
  • Interpersonal & communication skills.
  • Strong sense of self-esteem and confidence.
  • Good follow-through
  • Self-directedness.
  • Caring attitude and behavior
  • Assertiveness skills
  • Analytical skills

 

 

NB: “RAF offers Total Employment Cost packages with no additional contributions from the Employer, successful candidates are required to structure their packages in a manner that will suit their needs”


Job Title: Senior Officer: Field Case Management X2

The Road Accident Fund’s mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.

 

Note: This is a 6 Months Fixed Term Contract

 

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