Job Description

Job Summary

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: Interested candidates should submit their CV and cover letter, highlighting their experience related to the job functions and skills listed above to

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