Description:
PLEASE NOTE THAT NO CV'S WILL BE KEPT FOR FUTURE USE. ONLY APPLY IF YOU QUALIFY IN FULL.Introduction
Our client is an accredited managed health organisation that service clients in the medical scheme industry.
They are privileged to have one of the growing medical schemes in South Africa as a client and an opening exists for an experienced hospital benefit management case manager to join their team to support the growth in scheme membership.
Purpose of the position
To actively manage the clinical appropriateness and risk (both financial and clinical) of all hospital events and associated healthcare services in accordance with the relevant scheme rules, clinical protocols and funding guidelines. To participate in the clinical review of exceptional cases and to engage with various stakeholders including treating providers, hospital case managers, medical advisors and colleagues. Qualifications:
Registered Nurse Valid registration with SANC (please supply copy of current registration/ receipt)
Skills and Competencies Required:
3 to 5 years experience within a managed healthcare or medical scheme environment Thorough, well-grounded clinical knowledge of hospital admissions, Length of Stay and Level of Care Excellent knowledge of the South African Healthcare industry and prevailing legislation, current coding structures i.e. ICD10s, CPT4, NRPL, PMB conditions and clinical protocols Extensive clinical knowledge related to all aspects of patient management Solid understanding of value-based care Demonstrated ability to manage a portfolio of hospital cases Outcome focused with the ability to manage competing demands Establishing and maintaining effective relationships with key stakeholders. Ability to accurately update and maintain cases information. Excellent telephonic and written communication skills (will be tested) Computer literate MIP/ Medcaps Application System (knowledge/ experience will be advantageous) and MS Office Suite of Products Reporting MS Excel basic knowledge required (will be tested) Proficiency in English verbal and written Verbal proficiency in additional languages will be advantageous Compassionate and attentive listener you will need to interact with the family/ loved ones of members with long-stay hospital events Demonstrated ability to effectively deal with emotionally charged and stressful situations Self-motivator and the ability to work effectively in an independent environment Strong organisational and task prioritisation skills Outstanding multitasking skills Ability to research and analyse information High degree of accuracy and attention to d
07 Jul 2025;
from:
gumtree.co.za