Case Manager

Minimum QualificationsProfessional registration with Case management Association of South Africa ( CMASA)Professional Registration with the South African Nursing CouncilICD 10 Coding CertificateNQF 7/8 Professional Nurse with Basic qualifications Midwifery/Psychiatry/Community Health Nursing /Occupational Health Care/Degree in Nursing (BA Cur /BTech)RequirementsExtensive experience in Case Management (CRM, DM & ORM)Have proven computer proficiency in MS OfficeHave strong case management industry knowledge with ability to extract, organize and capture significant amount of electronic information with the ability to pay attention to details and accuracyHave the ability to work under pressure and stressful environmentBe prepared to work extended hours on and ad hoc basisClear security screening recordClear credit recordValid driver’s license (if applicable)Key ResponsibilitiesApply scheme rules as per benefit schedule clinical and financial policies, and Protocols.Provide critical management of Injury on duty and Health incidents (Heat disorders)as per Mine Accident Policy and submission of claims and required documentation to both Insurers (RMA+ WCA.)Management of Injury on duty cases to include appropriate referral to preferred provider hospital s and specialists/hospital updates/outpatient scheduling/ rehabilitation/Work hardening/FWC-PWC/COF assessment, back to work program and disability management.Form part of the multidisciplinary team in actively managing mines accident cases in collaboration with the responsible Occupational Medical Practitioner.Management of Mine Accident Fatal Cases Post-mortems and Forensic management.Ensure that applicable ICD 10 Codes are applied accordingly and appropriately: Primary and Secondary ICD10 Codes, Tariff Codes, Procedure codes, Nappi Codes etc.Interact with internal and External customers.Case Management of Occupational Diseases i.e., Silicosis, NIHL/COAD and CRTB/ Platinosis and occupational dermatitis.Ensure linkage to care of employees identified with risks during the surveillance programme as well as long term follow up and compliance including telemedicine consultations.Ensure the management and timeous review of Vulnerable employees, fit with restriction ,Long Covid ,Substance Use Disorders as per restrictions imposed by the OMP i.e., employees with the following diseases Cardiac/respiratory/immunological diseases/maternity/drug abuse /Insulin Dependence Diabetic/Epilepsy /Mental Health disorder and Employees on anticoagulation therapy including stage 4 and 5 Renal Failure on Renal dialysis.Medical Incapacity Management-Clinical and administrative Management of employees medically incapacitated.Building and maintaining relationships with stakeholders across the organisation and externally at all levels and crossfunctionally.Management of Temp Unfit and Permanent unfit employees in the management of medical absenteeism in collaboration with the OH team.Management of Benefit Medical Examination and exemployees who qualify for benefits under ODIMWA.Management of Post-Employment Benefits: TEBA program - TB Management and Home Base Care ( HBC).Conduct Clinical Auditing and quality management process to align to Clinical risk management process.Create Preauthorization of special cases: Mine Direct accounts according to Approvals Framework process(Occupational Health Requirements: Safety goggles, Audiograms, special occupational health Pathology test, special clinical management request etc).Maintain Death database and classification of deaths.Participate in Occupational Health Clinical Review Committee.Validation and reporting of Occupational Diseases and Injuries.Maintain and comply with SHE standards within the work environment.Management of employees with depleted benefits and referral into State services.Capture Occupational Sick Leave -Mine Accident and Occupational Diseases Linkage of employees identified with health risks to definitive care programmes.Coordinate and collaborate with schemes CMs with Clinical Case Management Processes (In Hospital Clinical Risk Management + Preauthorization) and Utilization Review. ( Mine Direct : Step Down: TB Cases , Adhoc – Health Management clinical funding approvals).Check and verify accuracy of RMA reports captured.Assist in collation of clinical reports from service provider to the OMP and possible refer back any applicable case back to PHC /Treating Dr as per medical schemes protocols and guidelines).Coordinate and collaborate with medical scheme CMs to Identify terminally ill patient with poor prognosis/that have reached MMI(Maximum Medical Intervention) for possible medical incapacitation and Ill health repatriation process.Participate in risk assessments and investigate and take appropriate action as per identified risks.Ensure that applicable ICD 10 Codes and Procedure codes are applied accurately as per ICD 10 Coding rules and regulations on the Companies Databases.