Integrated Care Case Manager

Medihelp Medical Scheme; Pretoria; On-site; ZAR 400,000 - 550,000; Full time

Job summary

Medihelp Medical Scheme is seeking an Integrated Care Case Manager to assess financial risks and coordinate healthcare solutions for hospitalized members. The successful candidate will utilize their nursing expertise to manage treatment benefits effectively, ensuring quality care and minimizing costs. This role requires strong communication and negotiation skills, along with a thorough understanding of the Medical Scheme Act.

Qualifications

• Grade 12 with a completed degree/diploma as a registered nurse.
• Currently registered with SANC.
• Four years of relevant experience in Managed Healthcare or nursing in a hospital.

Responsibilities

• Assess the financial risk and impact of hospitalized members.
• Coordinate treatment and ensure optimal allocation of benefits.
• Reduce complications and prevent re-admissions.

Skills

Communication skills

Negotiation skills

Decision-making skills

Customer focus

Computer literacy

Education

Registered nurse degree/diploma

Job description

Purpose of the position

The core purpose of the Integrated Care Case Manager role is to assess the financial risk and impact of a hospitalized member on the scheme, minimizing this risk by recommending cost-effective medical treatment at the most appropriate facility.

The Integrated Care Case Manager facilitates seamless coordination between Medihelp, the member, and service providers to ensure optimal allocation of treatment benefits, reducing complications and preventing re-admissions while effectively managing overall risk.

Requirements

Grade 12, with a completed degree/diploma as a registered nurse and currently registered with the SANC.

Four years of relevant experience in Managed Healthcare or experience as a registered nurse in a hospital environment,

Key Competencies

Good verbal and written communication skills

Computer literate

Customer focus

Good negotiation and decision-making skills

Comprehensive knowledge of the Medical Scheme Act

Willing to be multi-skilled in other sections within managed care