Our client is a leading medical scheme based in Pretoria, dedicated to providing comprehensive healthcare benefits to its members. They are committed to innovation, quality service, and the well-being of their clients. In line with their growth and commitment to excellence, they are seeking a dedicated and experienced Case Manager to join their team.Functions:Plan and optimise daily tasks to ensure timely updates of cases on the hospital list.Follow up on long-term and high-cost cases of hospitalised and home care patients.Identify the need for patient and hospital visits and provide documented feedback.Adhere to the escalation process for cases requiring input from management or the medical advisor.Manage telephonic calls and enquiries from clients and service providers efficiently.Coordinate services and care to prevent re-admissions and complications.Negotiate tariffs and discounts within scheme rules.Identify members for transfer to rehabilitation, sub-acute, and private nursing facilities for quality and cost-effective services.Initiate discharge planning early in hospital admission.Educate families about short-term medical benefits and general care exclusions.Communicate discharge plans and benefits to relevant parties.Document all communication and complete relevant information accurately.Communicate clinical funding recommendations to doctors, members, suppliers, and service providers.Identify and manage complicated and high-cost cases impacting the scheme financially.Skills:Proficiency in MS Word, Excel, Office, Outlook, and Internet.Strong organisational skills with attention to detail.Excellent negotiation skills.Bilingual in English and Afrikaans with strong interpersonal communication.Team player with a caring attitude.Flexible in adapting to changes and management decisions.Proficient in problem-solving techniques and record keeping.Leadership skills and ability to maintain good interpersonal relationships.Requirements:B Cur Degree / Diploma in Nursing.Minimum 5 years of experience as a nursing practitioner.At least 1 year of experience in the medical funding industry.Knowledge of ICD-10 & CPT coding, medical scheme rules, ERP, Workflow, and CAM.Remuneration:Competitive salary commensurate with experience.Exceptional benefits program including 23 days of annual leave, 8-hour workday with a 30min break, life cover, disability benefits, funeral cover, pension fund, medical aid, and more.Office perks: free parking, Wi-Fi, landline phone allowance, on-site gym, subsidised meals, free refreshments, Athletics Club, Pilates, and wellness programs.Dynamic team interactions, recognition programs, and incentives.Join Our Client: Be part of a team that values innovation, quality service, and the well-being of its members. Apply today to contribute to a leading medical scheme's success and make a difference in the lives of many.Application Process:
