Case Manager at AfroCentric Group

The Role

AfroCentric Group is looking for a Renal Case Manager to manage the spending of member funds by means of clinical interventions and managed care protocols.

Responsibilities and Duties

• Ensure clinical approval of authorised treatment plan
• Ensure the cost effective management of authorised treatment plan
• Ensure appropriate and cost effective out of hospital care for members
• Perform quality updates of system to ensure correct payments of treatment
• Attend to High Level Queries and ex-gratia updates
• Meet delivery objectives through working with other team members within and linked to the department / project
• Resolve operational performance variations and problems and escalate unresolved issues to higher levels
• Ensure delivery targets/objectives are met and operate in a supportive manner to achieve successful delivery
• Ensure appropriate, active and informative relationships with customers and relevant stakeholders are successfully achieved
• Address customer or stakeholder complaints in alignment with the policies and procedures and ensuring customer / stakeholder buy-in
• Identify treatment trends and patterns to manage clinical and financial risk
• Defined legal, statutory and regulatory compliance is maintained at the required standards
• Operational risk and governance structures, measures and frameworks are complied with and necessary action is taken to address issues, when necessary
• To ensure clinical appropriateness of care at lowest possible cost without compromising quality of care.
• To use appropriate tools such as Burden of Care Criteria in the application of discharge planning.
• To manage the risk to the client by assessing the quality of information

Competencies

• Computer Technology Skills
• Communication Skills
• Business Writing Skills
• Relevant systems knowledge and application
• Ability to negotiate and influence
• Problem Solving
• Numerical Ability
• Customer Focus
• Attention to Accuracy and Detail

Experience

• 5 years renal dialysis. Coding experience mandatory. 1 year transplant unit experience advantageous.
• At least two years case management experience
• Previous Unit management expereince will be advantageous
• Knowledge and application of dispensing of meds, surgical material & 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

Qualifications

• Degree / Diploma in nursing, midwifery and psychiatry and nephrology nursing.
• Current SANC professional nursing registration - Proof required.