Case Manager

Join our team and help make a real difference in healthcare.

KEY RESPONSIBILITIES
- Manage hospital utilisation and coordinate care between the medical scheme/managed care organisation, members, providers and the community.
- Verify eligibility of cover in accordance with medical scheme rules and membership files.
- Facilitate admission of the member to a suitable facility.
- Assess co-morbidities and monitor clinical status.
- Communicate with hospitals, treating doctors and healthcare professionals.
- Update the level of care, length of stay and value to the hospital (in line with clinical guidelines and protocols).
- Develop and facilitate discharge plans.
- Refer members to Disease Management where appropriate.
- Maintain accurate clinical and demographic records.
- Visit high cost members in hospital as required.
- Prepare and present cases at clinical meetings.
- Prepare reports and case summaries.
- Complete special projects and other assigned duties.
- Perform other duties as needed.

MINIMUM REQUIREMENTS
- Clinical degree or diploma recognised by either the HPCSA or SANC or South African Nursing Council OR SANC.
- Minimum 2 years’ experience in case management within a medical scheme, hospital or managed care.
- Experience with chronic illness and targeted disease states.
- Strong verbal and written communication skills.
- Customer service focus.
- Ability to solve problems in a customer friendly manner.
- Understanding of the South African healthcare industry and prescribing information (or relevant).
- Understanding of medical legislation.
- Disbursing and case of medical scheme and healthcare financing terminology.
- Current and continued registration with the accredited professional body with which the candidate aligns.

ADVANTAGEOUS
- Additional clinical qualifications.
- Operating Theatre or ICU experience.
- Quality management and medical records review experience.
- Hospital or primary care case management experience.

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