Case Manager - Medical Aid

Job Title: Case Manager - Medical Aid

Location:Tshwane Metro, Pretoria, Brooklyn
Job Type:Permanent, expected to work Full-Time hours
Primary Industry:Insurance
Secondary Industry:Health, Medical and related
Job Duties:

Plan and optimise daily tasks to update cases on the hospital list within the 8-hour turnaround time
Follow up on long-term and high-cost cases of hospitalised and home care patients
Identify the need for patient and hospital visits where possible and give documented feedback
Follow the escalation process for the referral of cases that require input from management or the team
Manage telephonic calls and inquiries from all clients and service providers
Co-ordinate services and care for members to prevent re-admissions and complications
Negotiate within the scheme rules regarding tariffs and discounts
Identify hospitalised members for transfer to rehabilitation sub-acute and private nursing facilities
Initiate discharge planning early in hospital admission
Inform family regarding short-term medical benefits and educate them regarding general care exclusions
Communicate with relevant parties about the discharge plan and benefits
Document all phone calls made to relevant parties
Complete and document all relevant information
Communicate clinical funding recommendations via hospital authorisation notes to doctors, members, and support staff
Identify and manage complicated and high-cost cases that have a financial impact on the scheme

Required Qualifications:

A completed degree or diploma as a registered nurse
Must be registered with the South African Nursing Council (SANC)
Experience, Knowledge and Skills:

Four years experience in Managed Healthcare with oncology and or experience in a oncology unit
Prior experience in a similar role
Ability to manage and prioritise workload effectively
Strong communication and interpersonal skills
Excellent negotiation skills
Knowledge of hospital procedures and medical terminology

Preferred Qualifications:

Additional certifications in case management or healthcare management
Working Conditions:The role involves working in an office setting, handling phone calls and interacting with clients and healthcare providers on a regular basis.
Company Branding:Medihelp is the proud medical aid of choice for more than 215,000 South Africans. We welcome employees who share our vision of shaping healthy, confident South Africans making the most of every life stage.

Closing date:23 July 2024