Manager : Field Case Management

Road Accident Fund; Johannesburg; On-site; ZAR 600,000 - 850,000; Full time

Job summary

A leading company in the healthcare sector seeks a Manager: Field Case Management to oversee case management strategies and manage claimant rehabilitation effectively. The ideal candidate will have significant experience in nursing or case management at a supervisory level, aiming to balance quality care with strategic objectives.

Qualifications

• Bachelor's degree or advanced diploma in Health Sciences required.
• Postgraduate qualification preferred.
• Registration with relevant health professional body necessary.

Responsibilities

• Manage all assigned cases and ensure effective case management.
• Provide oversight and guidance for claimant rehabilitation.
• Prepare and submit performance reports on case management.

Skills

Leadership

Stakeholder Management

Case Management

Health Sciences Knowledge

Policy Implementation

Education

Bachelor's Degree in Health Sciences

Postgraduate in Health Sciences

Job description

Job title : Manager : Field Case Management

Job Location : Gauteng, Johannesburg Deadline : June 23, 2025 Quick Recommended Links

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Key Performance Areas

Policy and Strategy Review and Implementation

• Provide input into the enhancement and implementation of the case management strategy and plan that ensure alignment with short-term and long-term objectives.
• Keep up to date with effective case management policy and practice execution strategies

Case Management and Administration

• Manage all assigned cases.
• Manage the appointment of caregivers and the provision of the necessary training.
• Ensure that case management programs objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.
• Present cases at case rounds / conferences to obtain multidisciplinary perpective & recommendations to achieve optimal outcomes.
• Manage the provision of claimants / caregiver care plan and compliance reporting.
• Manage claimants case management plans, authorizations, assessment, and levels of care.
• Manager the review of medical records to identify specific medical issues.
• Manager the development of practice and / or clinical guidelines for cost effective rehabilitation of care.
• Identify financial and business risks to the Fund and escalate accordingly.

Management of Claimant Rehabilitation Care

• Manage claimants progress and outcomes
• Manage and analyse the determination of the claimant needs and coordinate reasonable recommendations for all the necessary and identified modifications in line with the nature of claimant's medical condition.
• Manage an in-home assessments by Senior Officer : Field Case management to assess members overall health needs, which includes medication reconciliation.
• Manage the identification of gaps in care as claimants transition from a care facility back to their home.
• Provide management direction and guidance in ensuring that healthcare services are accounted for by liaising with relevant personnel for authorisations and ensuring compliance with case management procedures, staandards, and protocols.
• Manage the approval and appointment of service providers in line with the defined scope of work.
• Determine the suitable rehabilitation stay for the claimant based on the required level of care and monitor the implementation.
• Ensure that an ongoing support to the family is provided on coping mechanisims post discharge.
• Manage and monitor the rehabilitation plans of the claimant / client for effectiveness.

Integrating of Back to work and Community

• Corporate with the treating physician to obtain full or conditional release to return to work before injury becomes a lost time claim where ot is neccessary.
• Coordinates with the employer to develop a modified duty job for the injured worker who cannot immediately return ro his / her full pre-injury employment where required.
• Ensure succesful integration of the claimant back to the family and educate the claimant and family on the condition of the claimant.
• Identify community resources based on the claimants need.

Manage the Submission of Invoices

• Validate and quality assure invoices submitted to ensure that they are aligned to the services and treatments caimed for.
• Put measures in place to guard against the submission of fraudulent invoices.
• Manage the compliance of invoiced services from service providers and ensure validity in line with RAF Act and guidelines.
• Manage timeous payment of service providers.

Reporting

• Manage the completion of all relevant reports (timesheets, expenses, program specific reports) as per specified timelines and required standards.
• Provide report on all assigned cases, and the monthly rehabilitation reports of the claimants.
• Prepare and submit monthly and quarterly performance case management reports or as and when required to provide progress updates and / or inform management decisions.
• Ensure complete, timely, and accurate reporting with appropriate levels of escalation.
• Provide reports on the possibilities of back to work integration for claimants.
• Reporting on the cost associated with the undertaking certificate against what has been spent on care givers.

Stakeholder Management

• Build productive relationships with healthcare professionals to ensure adequate referral rates to achieve budgeted occupancy level.
• Ensure accurate service knowledge and advice and keep stakeholders informed of products and service options.
• Resolve stakeholder queries and complaints promptly.
• Manage relations with service providers and health professionals to ensure adherence in line with the protocols and service level agreement.

People Management

• Ensure the sourcing, development and retention of high-performance team.
• Manage the recruitment of operational workforce in line with employment equity targets
• Manage staff in the department to ensure that they achieve their objectives in line with strategic objectives of the RAF.
• Manage the implementation of human capital processes and procedures to control / regulate workplace conflict and / or institute corrective measures and consultation processes to address deviations from standards.
• Allocate, direct, motivate and evaluate subordinates to help them achieve their individual goals.

Qualifications

• Bachelor's Degree / Advanced Diploma in Health Sciences or Medical related Degree.
• Postgraduate in Health Sciences or Medical related qualification will be an added advantage.
• Registration with the relevant Health professional body

Experience

• Relevant 6-8 years' experience in Nursing or Case Management environment of which 2 (two) years must have been on a management / supervisory level / area of expertise.