Job Description

Closing Date 2023/11/16
Reference Number MMH231103-7
Job Title Professional Nurse: Case Manager
Position Type Permanent
Role Family Medical
Cluster Health Solutions
Remote Opportunity None of the time
Location - Country South Africa
Location - Province Eastern Cape
Location - Town / City Gqeberha
Introduction

Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation, and create value through unique insights of how to achieve specific outcomes by using a defined set of health capabilities.
Role Purpose

To assist in the enhancement and management of a cost-effective managed health care with the objective of promoting rational utilisation of health care facilities and containing associated costs generated by these services.
Requirements

• National Senior Certificate is essential

• It is essential to have a Nursing Diploma or Degree

• Minimum of 2 years clinical experience within a private hospital is essential

• The incumbent must be registered with SANC (South African Nursing Council) as a Registered Nurse

• Good understanding of the medical aid industry i.e. trends, competitors, legislation is essential

• Knowledge of clinical coding; ICD, NRPL and CPT is essential

• Knowledge of hospital tariffs and billing guidelines is an advantage

• Minimum of 1 years' experience in a managed care environment / case management would be an advantage

• MS Office proficiency

• Language proficiency in at least 2 South African official languages

Duties & Responsibilities

• Review of in-hospital patients for appropriateness of care, length of stay and level of care.

• Liaise with the service provider on clinical updates, as well as outstanding information.

• Engage with the treating doctor(s) to ensure appropriate treatment, length of stay and level of care is rendered.

• Discharge planning for in-hospital patients to ensure ongoing support and care post discharge.

• Communicate with the medical advisor on complex cases.

• Drive patient advocacy by coordinating in and post-hospital care where necessary.

• Educate and guide all members regarding health care and their benefits.

• Develop, implement and communicate the practice and/or the clinical guidelines for cost effective care.

• Authorise appropriate and cost-effective surgical care and treatment.

• Ensure the consistent and correct application of exclusions.

• Adhere to policies and procedures and take corrective action where necessary.

• Adhere to organisational best practice and legislative requirements.

• Take ownership of escalated and unresolved queries and ensure they are resolved timeously.

• Manage queries until resolution and update the incident details.

• Identify financial and business risks to the company and escalate accordingly.

• Drive and support effective teamwork within the department.

• Strive to demonstrate the Company's values daily.

• Collaborate with existing hospital case managers and care coordinators to ensure improved clinical outcomes.

• Collaborate with the relevant team/s in referral and management of high-risk beneficiaries.

Competencies

• Excellent telephone etiquette

• Effective communication skills xe2x80x93 verbal and written

• Accountability

• Planning and organising

• Problem solving

• Time management

• Attention to detail

• Interpersonal skills

• Customer orientation

• Results driven

• Empathetic nature

• Business Administration skills

Policy

We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.

Momentum Metropolitan