Clinical Case Manager - Pretoria
Salary Negotiable
Pretoria,
Gauteng
more than 14 days ago
Job brief
We are looking for a Case Manager to enhance the quality of cost-effective managed healthcare services to accomplish member satisfaction and to deliver affordable managed healthcare services.
Responsibilities
Case Management of authorised cases according to the acceptable LOS, LOC protocols and Scheme rules.
Report cases and give feedback weekly to Manager - Hospital Benefit Management
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 knowledege in order to deliver a cost-effective professional service and to give the nessecary 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
Qualifications Required
Minimum Staff Nurse
B Cur Degree/ Diploma in Nursing
1+ years’ experience gained in the medical funding industry = preferably
Minimum 5+ years’ experience as a nursing practitioner
Bilingual - Afrikaans and English
RSA Citizens only
Essential own transport and valid drivers license
Knowledge 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 Understanding of the Medical Scheme Rules and Benefit Options
Understanding and experience of the medical scheme industry
Experience in the medical funding industry
Salary
Highly competitive ctc (experience and qualifications)
Benefits: Medical aid and provident fund
Performance bonus'
We are looking for a Case Manager to enhance the quality of cost-effective managed healthcare services to accomplish member satisfaction and to deliver affordable managed healthcare services.
Responsibilities
Case Management of authorised cases according to the acceptable LOS, LOC protocols and Scheme rules.
Report cases and give feedback weekly to Manager - Hospital Benefit Management
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 knowledege in order to deliver a cost-effective professional service and to give the nessecary 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
Qualifications Required
Minimum Staff Nurse
B Cur Degree/ Diploma in Nursing
1+ years’ experience gained in the medical funding industry = preferably
Minimum 5+ years’ experience as a nursing practitioner
Bilingual - Afrikaans and English
RSA Citizens only
Essential own transport and valid drivers license
Knowledge 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 Understanding of the Medical Scheme Rules and Benefit Options
Understanding and experience of the medical scheme industry
Experience in the medical funding industry
Salary
Highly competitive ctc (experience and qualifications)
Benefits: Medical aid and provident fund
Performance bonus'
Recruiter: Oiled Solutions Recruitment