Case Manager - Medical Aid

Job Type : Permanent, expected to work Full-Time hours

Primary Industry : Insurance

Secondary Industry : Health, Medical and related

Job Duties :

• Plan and optimise daily tasks to update cases on the hospital list within the 8-hour turnaround time
• Follow 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 team
• Manage telephonic calls and inquiries from all clients and service providers
• Co-ordinate services and care for members to prevent re-admissions and complications
• Negotiate within the scheme rules regarding tariffs and discounts
• Identify hospitalised members for transfer to rehabilitation sub-acute and private nursing facilities
• Initiate discharge planning early in hospital admission
• Inform family regarding short-term medical benefits and educate them regarding general care exclusions
• Communicate with relevant parties about the discharge plan and benefits
• Document all phone calls made to relevant parties
• Complete and document all relevant information
• Communicate clinical funding recommendations via hospital authorisation notes to doctors, members, and support staff
• Identify and manage complicated and high-cost cases that have a financial impact on the scheme

Required Qualifications :

A completed degree or diploma as a registered nurse

Must be registered with the South African Nursing Council (SANC)

Experience, Knowledge and Skills :

• Four years experience in Managed Healthcare with oncology and or experience in a oncology unit
• Prior experience in a similar role
• Ability to manage and prioritise workload effectively
• Strong communication and interpersonal skills
• Knowledge of hospital procedures and medical terminology

Working Conditions : The role involves working in an office setting, handling phone calls and interacting with clients and healthcare providers on a regular basis.