Professional Nurse: Case Manager at Momentum Metropolitan Holdings Limited

Role Purpose    

• To 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.

Requirements    

• National Senior Certificate is essential
• It is essential to have a Nursing Diploma or Degree
• Minimum of 2 years clinical experience within a private hospital
• The incumbent must be registered with SANC (South African Nursing Council) as a Registered Nurse
• Good understanding of the medical aid industry i.e. trends, competitors, legislation is essential
• Knowledge of Clinical coding; ICD, NRPL and CPT is essential
• Minimum of 1 years experience in a managed care environment / case management would be an advantage
• MS Office proficiency 
• Language proficiency in at least 2 South African official languages

Duties & Responsibilities    

• Review of in-hospital patients for appropriateness of care and length of stay.
• Liaise with the service provider on the clinical update. 
• Discharge planning for in-hospital patients to ensure ongoing support and care post discharge.
• Communicate with the medical advisor on complex cases.
• Drive patient advocacy by coordinating in and post-hospital care where necessary.
• Educate and guide all members regarding health care and their benefits.
• Develop, implement and communicate the practice and/or the 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 practice and legislative requirements.
• Take ownership of escalated and unresolved queries and ensure they are resolved timeously.
• Manage the problem until resolution and update the incident details.
• Identify financial and business risks to the company and escalate accordingly.
• Drive and support effective teamwork within the department.
• Ensure to demonstrate the company's values daily.
• Collaborate with existing hospital case managers and care coordinators to ensure improved clinical outcomes.
• Collaborate with Disease Management team in referral and management of high-risk beneficiaries.

Competencies    

• Excellent telephone etiquette
• Effective communication skills – verbal and written
• Accountability
• Planning and organising
• Problem solving
• Time management
• Attention to detail
• Interpersonal skills 
• Customer orientation
• Results driven
• Empathetic nature 
• Business administration skills

Closing Date    
2023/05/10