Case Manager for Spinal Management Programme

SUMMARY:
12 MONTH CONTRACT WITH POSSIBILITY OF BECOMING PERMANENT IN PRETORIA - ON SITE.   FOR A CASE MANAGER WITH SPINAL PROGRAM MANAGEMENT EXPERIENCE.


The Health group is an accredited managed health organisation that service clients in the medical scheme industry.   They are  privileged to have one of the growing medical schemes in South Africa as a client and a new opportunity and position has presented itself in our commitment to ensure that our medical scheme beneficiaries are supported to access healthcare services.


To actively manage the access, clinical appropriateness and risk (both financial and clinical) of all requests for services pertaining
to back and neck pain management, spinal surgery, scans and associated healthcare services in accordance with the relevant
scheme rules, clinical protocols and funding guidelines.  To critically consider and propose relevant treatment alternatives that
include, but are not limited to, conservative treatment options like physiotherapy.  To participate in the clinical review of exceptional cases and to engage with various stakeholders including treating providers, hospital case managers, medical advisors and colleagues.

POSITION INFO:
PLEASE NOTE : DO NOT APPLY IF YOU ARE NOT FULLY QUALIFIED. NO CV WILL BE KEPT FOR FUTURE USE. IF YOU DO NOT GET FEEDBACK WITHIN 3 WEEKS PLEASE CONSIDER YOUR APPLICATION AS UNSUCCESSFUL.

Registered Nurse with valid registration with SANC
OR
Clinical Associate (Bachelor of Clinical Medical Practice (BCMP)) with valid registration with HPCSA.


Thorough, well-grounded clinical knowledge of hospital admissions, LOS and LOC.
Excellent knowledge of the South African Healthcare industry and prevailing legislation, current coding structures i.e.
ICD10’s, CPT4, NRPL, PMB conditions and clinical protocols.
Extensive clinical knowledge related to all aspects of holistic patient management.
Work experience within Orthopaedic and/ or Surgical theatre and wards will be advantageous.

Excellent telephonic and written communication skills (will be tested).
Computer literate - MS Office Suite (intermediate) required.
MIP Application System experience will be advantageous.
REPORTING - MS Excel (intermediate) required (WILL BE TESTED).

Proficiency in English – verbal and written
Verbal proficiency in at least two others of the national languages will be advantageous.
Ability to research and analyse information.
High degree of accuracy and attention to detail.
Maintaining confidentiality of information.
Knowledge of medical aid policies and procedures.
Interest in and/ or knowledge of Neuro-, Orthopaedic - and Spinal sergery.
Decision making skills.
Following through on commitments.

FOR FULL JOB SPEC PLEASE CONTACT

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