Medical Case Manager

Medical Case Manager - Jhb NorthIntroductionA health care provider needs a qualified RN Case Manger to join their multidisciplinary team.Duties & ResponsibilitiesLiaise with hospital Case Managers authorisations for procedures, casualty, specialist treatment, dental and general referralsFull management of hospital cases, issue payment guarantees, treatment, discharge and follow up careLiaise with the multidisciplinary team for optimal patient care and benefit utilisationAuthorisation for medication for special cases and off formulary itemsAnalysis of members clinical data and benefit usageIdentification and analysis of trends, mis-use and fraud related to benefitsLiaise with GPs regarding over use of in-house proceduresAttend to and resolve queries related to procedures and benefitsLog all calls and update records on the system, ensuring integrity of dataStandby on a rotational basis, including evenings and weekendsMonthly reporting on all casesDesired Experience & QualificationQualified Registered Nurse with current SANC registrationForensic risk management qualification and CFE registration2+ years experience in case managementExcellent oral and written communicationMS Office essential with MIP experience an advantageKnowledge of SA Health Industry and medical aid benefits, ICD 10 codes, RPL tariffs etc.Knowledge of clinical terms and able to interpret to membersKnowledge of medical claims profiling and auditingPackage & RemunerationR35 CTC, including Provident Fund, plus standby allowance
Johannesburg, GT, ZA