The ideal candidate will be a mature individual (older than 40-years of age) with more than seven years experience
within a hospital case management position. Must be eager to learn, healthy and fit. Needs to be able to speak and
understand Afrikaans. PLEASE NOTE: ONLY APPLY IF YOU QUALIFY IN FULL
Weekly rotation - 07H00 to 16H00 or 08H00 to 17H00 (Monday to Friday).
Telephonic standby every third week.
Qualifications
- Registered Nurse
- Valid SANC registration
- Seven or more years experience as a senior in a hospital setting.
- Experience as a Wellness nurse within a retail pharmacy/wellness service provider will be advantageous.
- Experience within a medical scheme/managed care organisation will be advantageous.
- Legal knowledge, i.e. Medical Schemes Act, POPIA, medical liability, etc.
- Knowledge of the South African Healthcare industry coding structures i.e. ICD10, CPT4, NRPL, PMB conditions and clinical protocols, etc.
- Extensive clinical knowledge related to all aspects of patient management, including home care.
- Excellent telephonic and written communication skills (will be tested).
- Computer literacy, MS Office especially intermediate knowledge of Excel (will be tested) and experience with an industry information system (e.g. hospital, medical scheme administration, or managed care).
- Proficiency in English verbal and written.
- Strong organisational and task prioritization, and multitasking skills.
- Ability to research and analyse information.
- Maintaining confidentiality of information.
- Decision-making skills.
- Following through on commitments.
- Flexibility to travel.
- Own transport and a valid drivers license.
- High degree of accuracy and attention to detail.
- Self-motivator and the ability to work effectively independently.
- Show initiative.
- Demonstrated ability to deal with emotionally charged and stressful situations effectively.
- Compassionate and attentive listener must be able to interact with the family/ loved ones of members with long-stay hospital events and members with complex disease profiles, including but not limited to chronic conditions, oncology, mental wellness, etc.
- Must be confident and comfortable with clinical decision-making.
- Confidential management of patient medical conditions, treatment, and funding information.
- Driving risk-based preventative intervention and care thorough the Schemes model and programmes, including health risk assessments (HRAs), hospital and home visits and assessments.
- Clinical coding per CPT4 and ICD10 requirements and as per client standards.
- Managing patient hospitalisation; including the receipt and verification of hospital clinical updates, coordinating the appropriate Level of Care (LOC) and Length of Stay (LOS), and contain hospital stay financial risk (discharge planning).
- Provide continuous, complete, and accurate updates and discharge information.
- Review the costs to ensure cost-effective and necessary care; balance cost and effectiveness of treatment to optimise access to care and facilities.
- Keep the medical advisor/s, scheme management, providers, and members informed, including the interpretation of medical reports, facilitating clinical decision-making, and the efficient escalation of challenging and unresolved cases including reporting.
- Interact with service providers relating to funding levels and updates.
- Manage patient chronic conditions through the active disease management programmes.
- Telephonic and written contact with all stakeholders, including but not limited to members, healthcare providers and the client.
