Case Manager X3 - Houghton Estate, South Africa - 3Sixty Health (Pty) Ltd

3Sixty Health (Pty) Ltd
3Sixty Health (Pty) Ltd
Verified Company
Houghton Estate, South Africa

2 weeks ago

Thabo Mthembu

Posted by:

Thabo Mthembu

beBee Recruiter
Description

3Sixty Health has a great opportunity for a suitably qualified individual to fulfil the advertised position and join their team.

3Sixty Health is a black owned and managed, reputable and a major player in driving


3SIXTY HEALTH South African economy by investing in ''black excellence''3Sixty Health is 100% black


BACKGROUND owned and black managed administrator. It is accredited by the council for medical schemes to offer both administration and managed care services, allowing for a fully integrated, beneficiary-centric approach. Our core competencies in administration include membership management, billing, claim adjudication and customer services.

It is a medical aid administrator of Sizwe Hosmed Medical Scheme.

Case Manager


POSITION
Operations Admin


DIVISION
Managed Health Care


DEPARTMENT
Head Office, Houghton, Gauteng


LOCATION


Promote optimal, quality, cost-effective health care services to members admitted in high-cost wards, throughout the continuum of care whilst in a healthcare facility without compromising quality of care.

Ensure proper risk management and integration of


JOB PURPOSE
preventative healthcare services with the objective of promoting self-management and better control of chronic conditions.


KEY RESPONSIBILITIES

  • Using clinical expertise to review, monitor, and coordinate specialty services admissions, proposed surgical procedures, utilizing approved clinical guidelines,
  • Reviewing clinical reports and records to determine medical necessity of proposed procedures and coordinating services at the appropriate level of care,
  • Identifying and managing members in need of intensive case management and targeted disease
- management initiatives,

  • Discussing cases with Medical Advisor regarding appropriateness of care and alternatives, and other services to meet the
  • Reviewing covered benefits and alternative community and governmentbased programs that may be available to member,
  • Monitoring patient outcomes: analysing existing policy and providing feedback as indicated.
  • Contributes to the team effort, maintains customer confidence, and identifies potential quality issues by attending department meetings, giving and receiving feedback,
  • Performing other duties and assignments as requested; accomplishing related results as needed; keeping information confidential; communicating quality of care issues.
  • Fostering relationships with staff at assigned hospitals to improve coordination of care at appropriate levels.
  • Handling of queries effectively and efficiently
  • Analysing and review of Highcost cases for presentation to clinical operations team
  • Handling of exgratia and CMS cases

REQUIRED QUALIFICATIONS & EXPERIENCE

  • Registered Nurse (with SANC) with at least 3 years Private Hospital experience
  • A sound knowledge of hospital claims and charges (NHRPL)
  • Sound knowledge of the Medical Schemes Act
  • Sound knowledge of Prescribed Minimum Benefits.
  • Good planning and prioritising abilities
  • Good analytical and problemsolving capabilities
  • Good computer skills (MS Word, MS excel, PowerPoint)
  • Excellent communication skills, both verbal and written
  • Hi Care / ICU / theatre experience advantageous.
  • Case management experience at least 2 yrs.
  • Code 8 driver's license an advantage.
-
COMPETENCIES:


  • Ability to work under pressure and as part of a team.
  • Willingness to work overtime when necessary.
  • Enthusiasm to accept and develop in a changing environment.
  • Attention to detail and accuracy.
  • Able to take responsibility and use own initiative

Job Type:
Permanent


Ability to commute/relocate:

  • Houghton Estate, Gauteng: Reliably commute or planning to relocate before starting work (required)

Application Question(s):

  • Do you have sound knowledge of hospital claims and charges (NHRPL)?

Education:


  • High School (matric) (required)

Experience:


  • Registered Nurse (with SANC) with at least
Private Hospital: 3 years (required)

  • Case management: 2 years (required)
Application Deadline: 2023/09/10
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