Medical Case Coordinator: Professional Nurse, Grade 1-3)- REF NO: HR 4/4/7/61 at The Department of Employment and Labour

REQUIREMENTS :

• A 4 years’ degree / 3 years’ diploma in Nursing. Post basic Diploma in Occupational Health/ Theatre Technique/ Critical Care will be an advantage. Valid Driver’s Licence is required. The following years of experience in trauma/emergency/internal medical/ general surgery/ orthopaedics/ theatre at the regional public hospital level or private hospital are required:
• Grade 1: 2-9 years’ experience gained after registration,
• Grade 2: 10-19 years’ experience gained after registration &
• Grade 3: 20 years above experience gained after registration. Experience in medical claims processing/ insurance environmental will be on an added advantage. Registration with South African Nursing Council.

Knowledge:

• Medical related Legislation, Medicines and related Substances Act, Medical aid knowledge (case management), Occupational Health knowledge, Regulatory Knowledge and Implementation, DeL and Compensation Fund objectives and business functions, Nursing legislation and related legal as well ethical nursing practices, Compensation fund policies, procedures and processes, Stakeholder and customers, Customer Service (Batho Pele Principles), Fund Values, Occupational Health and Safety Act (OHS), COIDA Act, Regulations and Policies, COIDA tariffs, Technical Knowledge, PFMA and National Treasury Regulations, General knowledge of the Public Service Regulations, Public service Act National Health Act and Health Act Skills: Post claims management and settlement, Claims handling, Claims verification and validation, Claims settlement management, Medical policy management, Clinical Excellence and Advisory, Project Management and Planning, Information Analysis and Interpretation, Digital Acumen/Medical systems (IT System Control Designs), Clinical risk mitigation, Clinical Coding, Quality Assurance and Improvement and Research and Benchmarking