Clinical Case Manager - Gauteng, Pretoria - Pretoria
Che Leigh Personnel Consultants
A well-established company is recruiting for a CLINICAL CASE MANAGER PRETORIA Purpose of the role: 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 What you will need? Enrolled/ Registered Nurse Valid registration with SANC 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, LOS and LOC. Excellent knowledge of the South African Healthcare industry and prevailing legislation, current coding structures i.e. ICD10's, 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 Application System and MS Office 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 Maintaining confidentiality of information Knowledge of medical aid policies and procedures Flexibility to travel and a valid driver's license Hospital case management experience will be advantageous Nursing experience in an ICU setting will be a big advantage Please send your cv and supporting to [Email Address Removed]. If you have not received any feedback within 2 weeks please assume that your application was not successful Desired Skills: nurse case management hospital
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