Case Manager

2 months ago

Pretoria, South Africa Qetello Holdings Full time

Our client 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. In line with their growth and commitment to excellence, they are seeking a dedicated and experienced Case Manager to join their team.

Functions:

  • Plan and optimise daily tasks to ensure timely updates of cases on the hospital list.
  • Follow up on long-term and high-cost cases of hospitalised 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.
  • Document all communication and complete relevant information accurately.
  • Communicate clinical funding recommendations to doctors, members, suppliers, and service providers.
  • Identify and manage complicated and high-cost cases impacting the scheme financially.

Skills:

  • Proficiency in MS Word, Excel, Office, Outlook, and Internet.
  • Strong organisational skills with attention to detail.
  • Excellent negotiation skills.
  • Bilingual in English and Afrikaans with strong interpersonal communication.
  • Team player with a caring attitude.
  • Flexible in adapting to changes and management decisions.
  • Proficient in problem-solving techniques and record keeping.
  • Leadership skills and ability to maintain good interpersonal relationships.

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.

Remuneration:

  • 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.

Join Our Client: Be part of a team that values innovation, quality service, and the well-being of its members. Apply today to contribute to a leading medical scheme's success and make a difference in the lives of many.

Application Process: Interested candidates should submit their CV and cover letter, highlighting their experience related to the job functions and skills listed above to recruitment2@medicalresources.co.za

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