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Case Manager

Western Cape , R25000 - R80000 Per Month
Sector: Medical / Health Services
Posted: Friday, 3 June 2022

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Job Details

The Company is a medical insurance company that offers affordable medical cover to individual and corporate clients. We are looking for a paramedic/nurse/Case Manager to join our team!

Have you worked in a hospital but just can’t work those long hours any longer? Are you a people person? Do you see yourself working in a fun and vibrant environment?

If you answered YES to the above questions, WE ARE LOOKING FOR YOU!!

What we are looking for:

• Minimum Grade 12

• Registration as a Registered Nurse or Enrolled Nurse (with SANC)/ Paramedic (Desirable)

• Experience working in a health care setting

• Work experience in a managed care environment

• Excellent people skills and a caring approach

• Bilingual

• Good communication skills (both verbal and written)

• Good planning and prioritizing abilities in order to meet targets and internal SLA’s

• An astute, logical, and motivated approach

• Knowledge and experience of BHF tariff codes, ICD 10, and CPT 4 codes

• Computer Literacy in Microsoft Office (MS Excel, Outlook, word, etc.)

• Good understanding of managed healthcare processes.

• Sound clinical knowledge of chronic medical conditions.


What we expect from you:

• Hospital pre-authorization and issuing guarantee of payment

• Telephonic assessment of patient's current clinical status and risk profile

• Approve/assess clinical treatment plans

• Define desired clinical outcomes for the patient and prevent re-admission to the hospital

• Telephonic case management and resolution of resultant queries within service levels

• Evaluating patient's progress at predetermined intervals and referring when appropriate

• Investigating problems and high-cost cases (hospital and chronic cases)

• Work within defined SLA’s

• Writing reports detailing patient progress, savings made, and expected future outcomes


What we offer in return:

• Salary: CTC Market Related

• Free Healthcare

• Pension Fund

• Relaxed and enjoyable environment

• Fun Days

• Dress-up days