Talent Pool: Case Manager MMH251111-3

Role PurposeTo assist in the enhancement and management of a cost-effective managed Health Care with the objective of promoting rational utilisation of Health Care facilities and containing associated costs generated by these services.RequirementsMatric is essentialBasic Diploma in Nursing (Enrolled Nurse) or Nursing Diploma or Degree is essentialRegistered with SANC (South African Nursing Council) is EssentialMinimum of 3-5 years of working experience within managed care or acute hospital environment is essentialMinimum of 5 years working experience within managed care is essentialExperience in Hospital Risk Management is desirableExperience in private institutions is desirableGood understanding of the medical aid industry i.e.trends, competitors, and legislation is essentialMust be computer literateDuties and ResponsibilitiesArrange post-hospital care where necessary.Educate and guide all members regarding health care and their benefits.Develop, implement and communicate the practice and/orthe clinical guidelines for cost-effective care.Authorise appropriate and cost-effective surgical care and treatment.Ensure the consistent and correct application of exclusions.Adhere to policies and procedures and take corrective action where necessary.Adhere to organisational best practices and legislative requirements.Take ownership of escalated and unresolved queries and ensure they are resolved timeously.Manage the problem until resolution, updating the incident detail with any status updates.Ensure the effective, accurate, and timeous completion of relevant documentation accompanying transactions.Communicate with providers to improve the cost efficiencies of health care delivery.Provide clear communication with regard to the outcomes and process.Ensure Service Level Agreements are met and exceeded.Engage in effective communication and delivery according to Service Level Agreements.Adhere to all procedures and processes to improve service delivery.Manage the cost of an in or out-patient episode by implementing appropriate policies and guidelines.Identify financial and business risks to the company and escalate accordingly.Drive and support effective teamwork within the department.Engage in appropriate training interventions to promote own professional development.Ensure to demonstrate the company's values on a daily basis.-346021296