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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