Case Manager (Ref: BWCM)
Remuneration: Market Related. Successful candidate to discuss directly with Client HR.

Position in the Medical sector in Pretoria - Gauteng
Posted On Friday 29 April 2022
Job Description:

The position reports to the Patient Admin Manager and will be responsible for the following performance areas:

  •  Responsible for the case management with the hospital
  •  Interactions with medical schemes to ensure authorizations are provided timeously
  •  Verification of clinical coding
  •  Ensures accurate application and interpretation of specialized wards criteria
  •  Provides support for the management of alternate fee structures
  •  Liaison with doctors on funder requirements when necessary
  •  Continuous performance and quality management
  •  Interpretation and implementation of scheme benefit rules
  •  Maintains client service principles to ensure client expectations are met

Bachelor’s Degree in nursing

  • Registered with the South African Nursing Council as a Professional Nurse or Registered Nurse
  •  Experience in a managed healthcare environment
  •  Knowledge of coding and coding regulations
  •  Intermediate knowledge of Microsoft Office Suite
  •  Knowledge of the rules and regulations regarding medical aid schemes
  •  Knowledge of Trifour system will be an advantage
  •  Independent problem-solving and decision-making kills.
  •  Good accuracy and attention to detail skills in order to maintain high standards of work output
  •  Ability to function well within a team.
  •  Understand the interrelationships between business processes
  •  Maintains a customer-focus mindset that acknowledges the value of the client.

A Consultant will be in touch if you are shortlisted for the position.  Please consider your application unsuccessful should you not have been contacted within 2 weeks.  We will keep your CV on our database and contact you should you match the criteria of any other vacancies.



Please contact Bronwyn Williams