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