Case Manager - South Africa
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. Key Activities Identify treatment trends and patterns to manage clinical and financial risk Defined legal, statutory, and regulatory compliance is maintained at the required standards Operational risk and governance structures, measures and frameworks are complied with and necessary action is taken to address issues, when necessary Ensure clinical approval of authorised treatment plan Ensure the cost effective management of authorised 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 extrait updates 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 Experience and Qualifications 5 years ward experience, 2 years experience hospital scheme case management advantageous. Degree / Diploma in nursing, midwifery, and psychiatry. Current SANC professional nursing registration. Proof of registration to be provided. Company Description – A formidable healthcare company that aims to deliver exceptional services.
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