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South Africa

Case Manager

Company Medihelp
Reference # Cicelia Strauss
Published 13/01/2022
Contract Type Permanent
Salary Market Related
Location Pretoria, Gauteng, South Africa
Introduction
The positions became vacant due to a promotion and resignation
Job Functions Administration
Industries Insurance
Specification

Plan and optimize daily tasks to update cases on the hospital list within the 8 hours turnaround time.

Following up on long term and high cost cases of hospitalised and home care patients.

Identify the need for patient and hospital visits where possible and give documented feedback.

Follow the escalation process for the referral of cases that require input from management or the medical advisor.

Managing telephonic calls and enquiries from all client and service provides.

Co-ordinating services and care from which a member will benefit to prevent re-admissions and complications.

Negotiations within the scheme rules regarding tariffs and discounts.

Identifying hospitalised members for transfer to rehabilitation, sub-acute and private nursing facilities, for quality cost effective services.

Initiate discharge planning early in hospital admission.

Inform family regarding short term medical benefit and educate them regarding general care exclusion.

Communicate with relevant parties about the discharge plan and benefits.

Document all phone call made to relevant parties.

Complete and document all relevant information.

Communicate clinical funding recommendations via hospital authorisation notes to doctor, member, suppliers and service providers.

Identify and manage complicated and high cost cases that have a financial impact on the scheme.
Requirements

Grade 12.

A completed degree or diploma as a Registered Nursing and must be registered with SANC.

Two (2) years’ experience in Managed Healthcare.

Must possesses knowledge of the following:

ICD-10 & CPT coding;

Medihelp medical scheme’s rules;

ERP;

Workflow;

CAM

Computer literate in MS Office.

Must have a K53 driving licence.

Successful completion of the selection process based on criteria that determine the candidate’s potential with regard to the following competencies:

Customer focus;

Good verbal and written English communication skills as well as proficiency in understanding Afrikaans spoken and written communication.

Teamwork;

Negotiation skills;

Decision making;

Must be able to function under stress.
Job Closing Date 21/01/2022
   
   
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Last Updated: 30-6-2021 [21.06.02.21]
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