Senior Officer: Field Case Management x3

Road Accident Fund; Durban; On-site; ZAR 580,000; Full time

Job summary

The Road Accident Fund seeks a Senior Officer: Field Case Management to oversee rehabilitation and healthcare for injured claimants. This role involves coordinating services, conducting assessments, and ensuring effective stakeholder engagement. A Bachelor's Degree in Nursing or a related field and at least 4 years of experience in a medical environment are required.

Qualifications

• Bachelor's Degree or Advanced Diploma in Nursing/Allied Health Professions required.
• At least 4 years’ experience in a medical environment.
• Valid code 8 driver’s license needed.

Responsibilities

• Drive rehabilitation and healthcare needs of the injured.
• Conduct home visits and educate claimants.
• Monitor rehabilitation post-discharge.

Skills

Planning

Organizing

Client Service Orientation

Education

Bachelor's Degree or Advanced Diploma in Nursing/Allied Health Professions

Tools

ICD and CPT coding

Healthcare operations knowledge

Job description

Division: 0300

Reference No: 5154

Location: Durban, Kwazulu-Natal, ZA

Employment Type: Fixed Term Contract

Disability (EE targeted role): Yes

T.A.S.K Grade: 12

Job Posting Salary: R579,259.00

Job Posting End Date: 27 May 2025

The Road Accident Fund’s mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.

Purpose of the Job: The Senior Officer: Field Case Management is responsible for driving the rehabilitation and healthcare needs of the injured.

Note: This is a 12 Month Fixed Term Contract. (Re-advertisement)

Key Performance Areas

Field Case Management

• Activate an undertaking certificate and compile a case management report
• Conduct a home visit and educate the claimant on offerings of the undertaking and explain the overall process
• Conduct follow-up assessments and make recommendations based on the assessment
• Coordinate referrals to service providers aligned to the claimants’ needs
• Ensure successful integration of the claimant back into the family and educate on the condition of the claimant
• Facilitate timely consultation with medical service providers
• Provide vocational guidance post-accident and explore return-to-work opportunities

Rehabilitation Services

• Monitor rehabilitation post-discharge
• Review drug utilization and applications
• Assess caregiver needs and financial implications
• Recommend home and vehicle modifications based on medical condition
• Coordinate admission and necessary authorizations
• Facilitate hospital transfers and caregiver appointments
• Manage submission of timesheets for payment processing

Invoice Submission & Management

• Validate service provider accounts per RAF guidelines and the Road Accident Fund Act
• Monitor claims for over-servicing, abuse, or fraud
• Ensure timely payment of valid accounts
• Confirm that claimed services are accident-related
• Compare therapeutic modalities and surgical techniques for clinical guidelines development

Reporting

• Compile and update case management reports
• Report on patient care and ongoing rehabilitation
• Report on services provided by service providers

Stakeholder Management

• Drive stakeholder engagement for care facilitation
• Maintain relations with health specialists
• Participate in community awareness of RAF services
• Communicate effectively with stakeholders
• Engage in external RAF activities and events
• Maintain ongoing engagement with service providers

Qualifications

• Bachelor's Degree or Advanced Diploma in Nursing/Allied Health Professions or related field
• Registration with the relevant Health Professions Council

Experience

• At least 4 years’ experience in a medical environment
• Experience in Managed Healthcare
• Valid code 8 driver’s license

Behavioral Competencies

• Planning, Organizing, and Coordinating
• Personal Mastery
• Judgment and Decision Making
• Ethics and Values
• Client Service Orientation

Technical Competencies

• Knowledge of ICD and CPT coding (advantageous)
• Core competencies in case management
• Knowledge of healthcare operations
• Ability to maintain patient confidentiality
• Knowledge of medical tariffs and treatment plans
• Coding standards and protocols
• Understanding of PFMA for claim analysis

NB: RAF offers Total Employment Cost packages with no additional contributions from the employer. Successful candidates should structure their packages accordingly.

The Road Accident Fund promotes employment equity; preference will be given to People with Disabilities.

Applicants not contacted within six weeks of the closing date can consider their application unsuccessful.

Security vetting will be conducted for all prospective employees.

Applicants must have foreign qualifications evaluated by SAQA and provide proof of evaluation.