Case Manager

Case Manager
Position: Case Manager
Department: General and Specialized Case Management
Grade: B4M1
Position Purpose: To ensure clinical appropriateness of care at the 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 in hospital scheme case management advantageous.
Qualifications: Degree / Diploma in nursing, midwifery, and psychiatry. Current SANC professional nursing registration. Proof of registration to be provided.
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 the system to ensure correct payments of treatment.
Attend to High-Level Queries.
Gratia updates.

Knowledge:

Knowledge and application of dispensing of meds, surgical material & procedures.
Application of financial and risk assessment methodology.
Knowledge of scheme rules and contractual negotiations.
Application of clinical intervention principles.
Advise on best practice health risk solutions to relevant parties.
Knowledge and application of relevant legislation.
Knowledge and application of processes and procedures.

Skills:

Computer Technology Skills.
Task Management.
Adobe Creative Suite.
Data modeling and evaluation.
Communication Skills.
Business Writing Skills.
Relevant systems knowledge and application.
Ability to negotiate and influence.
Problem solving and decision-making skills.
Numerical Ability.
Customer Focus.
Attention to Accuracy and Detail.


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