Case Manager - Pretoria, South Africa - iMedrecruit

iMedrecruit

Verified Company

Pretoria, South Africa

1 week ago

Posted by:

Thabo Mthembu

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Description

About the job Case Manager (Member Management) 12 Month FTC - Pretoria

Case Manager (Member Management) 12 Month FTC - Pretoria
Our client, focusing on a risk and clinical assessment offering, is requiring a Case Manager (Member Management).

Requirements (but not limited to)

Perform Clinical coding in accordance with CPT and ICD requirements and as per client standards.
Maintaining patients clinical status in accordance with funder approval requirements for the duration of hospitalisation; keeping patients informed and managing the entire hospital stays financial risk
Provide complete and accurate updates and discharge information
Receive hospital updates and assess each case based on clinical info allocation of appropriate Length of Stay if clinically necessary
Update Level of Care based on clinical information
Review the costs to ensure cost effective and necessary care; balance cost and effectiveness of treatment to reduce readmission
Investigate and prepare cases for communication to the medical advisors, scheme, providers and members
Member management of hospitalised patients with Chronic conditions who are registered on the active disease management programmes.
Facilitation of the chronic and active disease registration of hospitalised beneficiaries who are diagnosed with one or more CDL conditions
Escalation and resolution of unresolved highcost cases
Identification and preparation of high cost / high risk incidents and reported weekly to Clinical Specialist
Discharge planning
Communication with and support to Medical Advisors
Call and written contact with Members and Providers
Contact SMS with members
Follow up on active cases with service providers relating to funding levels and updates (daily)
Interpretation of medical reports
Clinical decision making

Qualification:

3 to 5 years experience within a managed healthcare or medical scheme environment
Enrolled/ Registered Nurse
Valid registration with SANC

Skills and attributes:

Thorough, wellgrounded clinical knowledge of hospital admissions, LOS and LOC.
Excellent knowledge of the South African Healthcare industry and prevailing legislation, current coding structures i.e. ICD10s, CPT4, NRPL, PMB conditions and clinical protocols
Extensive clinical knowledge related to all aspects of patient management.
Solid understanding of valuebased care
Demonstrated ability to manage a portfolio of hospital cases
Outcome focused with the ability to manage competing demands
Establishing and maintaining effective relationships with key stakeholders.
Ability to accurately update and maintain cases information.
Excellent telephonic and written communication skills (will be tested)

Computer literate

MIP Application System and MS Office
Reporting MS Excel basic knowledge required (will be tested)
Proficiency in English verbal and written
Verbal proficiency in additional languages will be advantageous
Compassionate and attentive listener you will need to interact with the family/ loved ones of members with longstay hospital events
Demonstrated ability to effectively deal with emotionally charged and stressful situations
Selfmotivator and the ability to work effectively in an independent environment
Strong organisational and task prioritisation skills
Outstanding multitasking skills
Ability to research and analyse information
High degree of accuracy and attention to detail
Maintaining confidentiality of information
Knowledge of medical aid policies and procedures.
Decision making skills
Following through on commitments
Flexibility to travel and a valid drivers license
Hospital case management experience will be advantageous
Nursing experience in an ICU setting will be a big advantage