Position:
Case Manager In Hospital
Position Purpose:
To coordinate care in allocated facilities, in order to improve health outcomes and manage the cost to the Scheme(s). The case manager's responsibilities start from patient admission to discharge and they should have an understanding of hospital processes and the importance of making cost-effective decisions. To manage the Scheme risk by doing patient verification, assessing the quality of information received and obtaining the required clinical information to make a funding decision in line with Scheme rules and Standard Operating Procedures. This role is central to utilization review, evaluating healthcare treatments and negotiating the most cost-effective options available while adhering to ethical and legal standards.
Experience:
A minimum of 2 years of case management experience (private sector). At least 5 years of medical and surgical ward experience, and at least 2 years of experience in ICU or high care. Computer literacy (Outlook, Word, Excel) is required. A Code 08 driver’s license and own transport are essential, with extensive traveling expected. Willingness to work outside of normal office hours from time to time is necessary.
Qualifications:
Registered Nurse, Professional Membership
Knowledge:
- Knowledge and application of dispensing of medications, surgical materials & procedures
- Application of financial and risk assessment methodology
- Knowledge of scheme rules and contractual negotiations
- Application of clinical intervention principles
- Advise on best practice health risk solutions to relevant parties
- Knowledge and application of relevant legislation
- Knowledge and application of processes and procedures
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