Job Description

QUALIFICATIONS AND EXPERIENCE:

• Matric essential.
• Nursing Diploma or Degree essential.
• Minimum of 2 years clinical experience within a private hospital is essential.
• Must be registered with SANC (South African Nursing Council) as a Registered Nurse. (Enrolled/Staff Nurses will not be able to apply).
• 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
• Open to SA citizens with a clear criminal and credit history.
• Valid unendorsed Driverxe2x80x99s License with own vehicle (advantageous).

ROLES AND RESPONSIBILITIES:
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.
Reporting to the HOD, your performance areas include, but are not limited to:

• 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.

IMPORTANT ATTRIBUTES

• Must possess an ownership mentality and a willingness to take responsibility for tasks through to completion.
• Attention to detail, goal orientated and a desire to achieve your objectives.
• Problem solving.
• Planning and organising.
• Excellent telephone etiquette.
• Accountability.
• Effective communication skills xe2x80x93 verbal and written.
• Time management.
• Interpersonal skills.
• Customer orientated.
• Results driven.
• Empathetic nature.
• Business Administration skills.

Location: Port Elizabeth (no relocation assistance is provided for out-of-town candidates)
Profile: Healthcare and Medical
Career Level: 2+ years.
Employment: Permanent, full-time
E.E. / Non-EE: Preference will be given to AC&I applicants in line with the company's Employment Equity Plan.
Working Hours: Monday to Friday. 08H00 - 17H00
Remuneration: Market related basic + Benefits and 13th cheque

Short listed candidates may be expected to complete and pass assessments before moving to the next stage of the recruitment process.
Should you not be contacted within two weeks, please consider your application unsuccessful.