Case Manager

Case ManagerPosition:Case ManagerDepartment:General and Specialized Case ManagementGrade:B4M1Position Purpose:To ensure clinical appropriateness of care at lowest possible cost without compromising quality of care.
To use appropriate tools such as Burden of Care Criteria in the application of discharge planning.
To manage the risk to the client by assessing the quality of information received and sent out and anticipating the cost for the scheme.
To recognize the skills and the resources available to facilitate a successful recovery.Experience:5 years ward experience, 2 years' experience hospital scheme case management advantageousQualifications:Degree / Diploma in nursing, midwifery, and psychiatry.
Current SANC professional nursing registration.
Proof of registration to be provide.Generic Objectives:Compliance and Risk Management:Identify treatment trends and patterns to manage clinical and financial risk.Ensure clinical approval of authorized treatment plan.Ensure the cost-effective management of authorized treatment plan.Ensure appropriate and cost effective out of hospital care for members.Perform quality updates of system to ensure correct payments of treatment.Attend to High Level Queries and ex.
Gratia updatesKnowledgeKnowledge and application of dispensing of meds, surgical material & proceduresApplication of financial and risk assessment methodologyKnowledge of scheme rules and contractual negotiationsApplication of clinical intervention principlesAdvise on best practice health risk solutions to relevant partiesKnowledge and application of relevant legislationKnowledge and application of processes and proceduresSkills:Computer Technology SkillsTask ManagementAdobe Creative SuiteData modelling and evaluationCommunication SkillsBusiness Writing SkillsRelevant systems knowledge and applicationAbility to negotiate and influence.Problem solving and decision-making skills.Numerical AbilityCustomer FocusAttention to Accuracy and Detail