Manager: Field Case Management- Groote Schuur / Tygerberg Hospital at Road Accident Fund

Key Performance Areas

Policy and Strategy Review and Implementation

• Provide input into the enhancement and implementation of the case management strategy and plan that ensure alignment with short-term and long-term objectives.
• Keep up to date with effective case management policy and practice execution strategies

Case Management and Administration

• Manage all assigned cases.
• Manage the appointment of caregivers and the provision of the necessary training.
• Ensure that case management programs objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.
• Present cases at case rounds/conferences to obtain multidisciplinary perpective & recommendations to achieve optimal outcomes.
• Manage the provision of claimants/ caregiver care plan and compliance reporting.
• Manage claimants case management plans, authorizations, assessment, and levels of care.
• Manager the review of medical records to identify specific medical issues.
• Manager the development of practice and/or clinical guidelines for cost effective rehabilitation of care.
• Identify financial and business risks to the Fund and escalate accordingly.

Management of Claimant Rehabilitation Care

• Manage claimants progress and outcomes
• Manage and analyse the determination of the claimant needs and coordinate reasonable recommendations for all the necessary and identified modifications in line with the nature of claimant's medical condition.
• Manage an in-home assessments by Senior Officer: Field Case management to assess members overall health needs, which includes medication reconciliation.
• Manage the identification of gaps in care as claimants transition from a care facility back to their home.
• Provide management direction and guidance in ensuring that healthcare services are accounted for by liaising with relevant personnel for authorisations and ensuring compliance with case management procedures, staandards, and protocols.
• Manage the approval and appointment of service providers in line with the defined scope of work.
• Determine the suitable rehabilitation stay for the claimant based on the required level of care and monitor the implementation.
• Ensure that an ongoing support to the family is provided on coping mechanisims post discharge.
• Manage and monitor the rehabilitation plans of the claimant/ client for effectiveness.

Integrating of Back to work and Community

• Corporate with the treating physician to obtain full or conditional release to return to work before injury becomes a lost time claim where ot is neccessary.
• Coordinates with the employer to develop a modified duty job for the injured worker who cannot immediately return ro his/her full pre-injury employment where required.
• Ensure succesful integration of the claimant back to the family and educate the claimant and family on the condition of the claimant.
• Identify community resources based on the claimants need.

Manage the Submission of Invoices

• Validate and quality assure invoices submitted to ensure that they are aligned to the services and treatments caimed for.
• Put measures in place to guard against the submission of fraudulent invoices.
• Manage the compliance of invoiced services from service providers and ensure validity in line with RAF Act and guidelines.
• Manage timeous payment of service providers.

Reporting

• Manage the completion of all relevant reports (timesheets, expenses, program specific reports) as per specified timelines and required standards.
• Provide report on all assigned cases, and the monthly rehabilitation reports of the claimants.
• Prepare and submit monthly and quarterly performance case management reports or as and when required to provide progress updates and/or inform management decisions.
• Ensure complete, timely, and accurate reporting with appropriate levels of escalation.
• Provide reports on the possibilities of back to work integration for claimants.
• Reporting on the cost associated with the undertaking certificate against what has been spent on care givers.

Stakeholder Management

• Build productive relationships with healthcare professionals to ensure adequate referral rates to achieve budgeted occupancy level.
• Ensure accurate service knowledge and advice and keep stakeholders informed of products and service options.
• Resolve stakeholder queries and complaints promptly.
• Manage relations with service providers and health professionals to ensure adherence in line with the protocols and service level agreement.

People Management

• Ensure the sourcing, development and retention of high-performance team.
• Manage the recruitment of operational workforce in line with employment equity targets
• Manage staff in the department to ensure that they achieve their objectives in line with strategic objectives of the RAF.
• Manage the implementation of human capital processes and procedures to control/ regulate workplace conflict and/or institute corrective measures and consultation processes to address deviations from standards.
• Allocate, direct, motivate and evaluate subordinates to help them achieve their individual goals.

Qualifications

• Bachelor's Degree/ Advanced Diploma in Health Sciences or Medical related Degree.
• Postgraduate in Health Sciences or Medical related qualification will be an added advantage.
• Registration with the relevant Health professional body

Experience

• Relevant 6-8 years' experience in Nursing or Case Management environment of which 2 (two) years must have been on a management/ supervisory level/ area of expertise.