Clinical Case Manager/CCA at Rand Mutual - RMA

Purpose

• Reporting to the Clinical Claims Adjudications Manager, the incumbent will be responsible for effectively and efficiently processing pre-authorisations for Compensation for Occupational Injuries and Diseases Act (COIDA) accidents.

Qualifications and Experience Required:

• Degree in: Nursing / Medical
• Valid registration with professional body
• Medical Knowledge at NQF6 level
• Knowledge of administrative and clerical procedures
• Computer literate - MS Office
• Knowledge of Customer Service principles and practices
• Valid Driver's License and own transport
• At-least 2-3 years Case management experience

Key Areas of Responsibility

• Generate the pre-authorisation and feedback to MSP timeously
• Generate the hospital pre-authorisation and feedback to MSP timeously
• Generate pre-authorisation for Chronic medication for non-pensioners and supply feedback to MSP
• Authorise all Devices as per approval
• Ensure that all mandatory tariff codes are captured on authorization
• Medical management of Severe Injury claims
• Follow up on outstanding medical reports with Medical Service Providers
• Review and updating of ICD10 codes
• Updating of system with outstanding medical requirements
• Pre-authorisation of medical treatment in line with internal policies and Standard Operating Procedures
• Submission of periodical and monthly reports to Management
• Undertake relevant training as identified by line manager
• Training and coaching of Junior Staff and Medical Service Providers
• Adherence to Company Policies and Standard Operating Procedures
• Resolution of queries and complaints from stakeholders
• Participation in Company projects as and when requested

Knowledge, Skills and Competencies required:

• Excellent numeracy skills
• Building customer loyalty
• Contributing to team success
• Managing work and time management
• Stress tolerance
• Decision making