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17 May 2022

Permanent Job for Unemployed Medical Case Manager Needed

BQuad Solutions – Posted by JobWire24 Randburg, Gauteng, South Africa

Job Description

Job for Unemployed Medical Case Manager Needed

Location: Johannesburg North

Job Type: Permanent

Company/Employer: BQuad Solutions

Job Title: Job for Unemployed Medical Case Manager Needed


Introduction

  • Duties & Responsibilities
  • Liaise with hospital Case Managers – authorisations for procedures, casualty, specialist treatment, dental and general referrals
  • Full management of hospital cases, issue payment guarantees, treatment, discharge and follow up care
  • Liaise with the multidisciplinary team for optimal patient care and benefit utilisation
  • Authorisation for medication for special cases and off formulary items
  • Analysis of members clinical data and benefit usage
  • Identification and analysis of trends, mis-use and fraud related to benefits
  • Liaise with GP’s regarding over use of in-house procedures
  • Attend to and resolve queries related to procedures and benefits
  • Log all calls and update records on the system, ensuring integrity of data
  • Standby on a rotational basis, including evenings and weekends
  • Monthly reporting on all cases
  • Desired Experience & Qualification
  • Qualified Registered Nurse with current SANC registration
  • Forensic risk management qualification and CFE registration
  • 2+ years experience in case management
  • Excellent oral and written communication
  • MS Office essential with MIP experience an advantage
  • Knowledge of SA Health Industry and medical aid benefits, ICD 10 codes, RPL tariffs etc.
  • Knowledge of clinical terms and able to interpret to members
  • Knowledge of medical claims profiling and auditing

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