Case Manager: Hospital Risk Management at Momentum Metropolitan Holdings Limited

Role Purpose    

• To assist in the enhancement and management of cost-effective managed health care with the objective of promoting rational utilisation of health care facilities and containing associated costs generated by these services.

Requirements    

• A National Senior Certificate is essential
• It is essential to have a Nursing Diploma or Degree
• Minimum of 1 year’s clinical experience within a private hospital
• The incumbent must be registered with SANC (South African Nursing Council) as a Registered / Professional Nurse
• Experience in a managed care / case management environment would be an advantage
• MS 365 proficiency 

Duties & Responsibilities    

• 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.
• Develop, implement and communicate the practice and/or 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.
• Provide clinical support to non-clinical team’s if/when required.
• Drive and support effective teamwork within the department.
• Strive to demonstrate the company's values daily.
• Engage in hospital visits where needed to build stakeholder relationships, proactively resolve queries and increase visibility to members.
• Ensure the effective, accurate and timeous completion of relevant documentation and recording of interventions.
• Communicate with providers to improve the cost efficiencies of health care delivery.
• Ensure Service Level Agreements are met and exceeded.
• Continuously develop own expertise in terms of industry and subject matter development and application thereof in an area of specialisation.

Competencies    

• Effective communication skills – verbal and written
• Accountability
• Planning and organising
• Problem solving
• Time management
• Attention to detail
• Interpersonal skills 
• Customer orientation
• Results driven
• Empathetic nature 
• Business administration skills

Closing Date    

• 2026/03/15