Kaelo provides innovative, essential, healthcare solutions enabling the physical and psychological well-being of all South Africans.
Our one goal is to provide more South Africans with access to quality healthcare. We are progressive in our design, simple in our approach and sincere in the way we engage, changing the way healthcare is delivered to meet th...
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Answering calls routed through for casualty or hospital treatment and admission.
Identify exclusions from the onset of request for treatment.
Ensure that correct benefit is utilised by member.
Correct level of care is allocated to the correct facility.
Latest medical guidelines are used within the available benefit.
Reporting on cases actioned per month including savings.
Report any clinical escalations/concerns to the clinical Review team.
Act as a patient advocate
Maintain all the confidentiality in clinical conditions shared with her/him.
Review latest appliances used in hospital against the current treatment guidelines.
Educate patients on benefit and limitations on their insurance option.
Developing referral and treatment protocols for new or updated conditions identified.
Discussing diagnosis with doctors, specialists and other health care providers,
Conducting assessments of patient needs, such as mental health issues or substance abuse problems and refer to EAP where applicable.
Providing information about treatment options, side effects, and possible complications of medications or procedures
Assisting with monthly reporting on statistics
Utilize all resources and guidelines at his/her disposal to effectively assess, prioritize, advise, and manage patients admitted.
Thoroughly complete documentation utilizing the appropriate computer software in compliance with the approved policies and procedures.
Maintain current nursing skills and knowledge base by attendance at workshops and seminars, completion of mandatory continuing education, reading of professional journals, publications, and participation in professional organizations.
Qualifications
Required
Registered Nurse
Degree /Diploma in Nursing
ICU/Operation theatre trained, or experience is an advantage.
2 years hospital Case Management experience would be beneficial.
Medical Aid or Insurance industry experience will be an advantage.
Sound knowledge of ICD and CPT coding and DRG’s
Preferred
Professional Nurse with SANC registration
Prefer minimum of three years recent clinical experience in health, critical care and/or emergency room.
Familiarity/experience with patient interactions on the telephone
Gmail
Yahoomail