Client in managed healthcare is looking for an experienced and qualified Nurse for a Clinical Case Manager position. Hospital benefit management experience essential.
This position reports to the Senior Manager

Responsibilities:
Case Management of authorised cases according to the acceptable LOS, LOC protocols and Scheme rules
Report cases and give feedback over R100 000 weekly to Manager - Hospital Benefit Management Department
To ensure that clinical notes are captured correctly to manage the pre-authorized and hospital cases according to the acceptable LOS, LOC, protocols and Scheme rules
To reduce the risk associated with hospitalization and to provide an effective and unique managed healthcare department
Attending work shops on a regular basis to gain adequate/up-to-date knowledge in order to deliver a cost-effective professional service and to give training to the personal
Negotiating with the different suppliers for discount on a prosthesis in cases where the prosthesis amount is above the members limit
In case of a long term patient – to make contact with the treating doctor for possibility of step down facilities for cost effectiveness

Skills Required:
Thorough, well-grounded clinical knowledge of Pre Authorization of hospital admissions and

Case Management of hospital cases in order to take cost-effective and appropriate decisions in evaluating treatment, LOS and LOC.

Knowledge of the current coding structures in the South African Health Care environment i.e. ICD10’s, CPT4, NRPL, and PMB conditions, protocols and Scheme rules

Minimum Educational & Work Experience Requirements:
Grade 12
B Cur degree / Diploma in Nursing (not negotiable)

Min 1 years experience within a medical aid environment (not negotiable)
Hospital benefit management experience NB
Bilingual - Afrikaans and English (not negotiable)

Salary:
R 22 000.00 - R 25 000.00 pm ctc incl medical aid and provident fund
Plus yearly performance bonus