CASE COORDINATOR

DESCRIPTION

(6 Months Fixed Term Contract)

A leading organisation in the healthcare service industry is seeking to recruit a highly qualified individual to join our dynamic team. Applications are invited from suitably qualified and experienced candidates for the above-mentioned position.

Key Responsibilities
Reporting to the Hospital Benefits Management Supervisor, the position shall be responsible for the following, among other duties: –
> Contributes to the development of case management protocols and guidelines for key identified cost drivers;
> Coordinates care with specialists and other health care providers;
> Negotiates appropriate care to meet client needs in the most cost-effective settings;
> Establishes actual and potential health problems, objectives for treatment and desired outcomes using the nursing process;
> Provides information to the admitting facility regarding member’s health benefits available to avoid unpaid claims;
> Establishes whether a patient has a proper support system before discharge from the hospital and provides necessary counselling;
> Coordinates the management of hospital claims adjudication, pricing, and reimbursement for in-network hospitals;
> Identifies and pre-authorises high-cost hospital procedures and processes that are within authority;
> Attends to hospital queries in line with approved policies and procedures;
> Ensures best practice and up-to-date communication with and between stakeholders.

Person Specifications
> 5 0 Levels including English and Mathematics;
> Diploma in Nursing;
> Highly computer literate;
> 3 years’ experience in Clinical Nursing;
> Experience in a medical claims assessing environment will be an added advantage.