Pensions Medical Case Auditor - Welkom at Rand Mutual - RMA

WHAT WILL YOU DO?

• Monitoring of Hospital Admissions weekly and liaison with Case Managers.
• Give feedback to Case Managers and other Colleagues of Pensioners admitted in Hospitals and include for hospital utilisation management.
• Authorization of Pensioners Hospital admissions, Chronic Medications and Sundries, prosthetic repairs and replacement
• Adjudicate requests for subsequent care and refer to RMA doctor as necessary.
• Assess and adjudicate medical service provider reports and advise on invoices submitted and captured when requested.
• Visit medical service providers and hospitals to address Pensioners related issues
• Organize and attend scheduled clinics.
• Organize transport for SCI acute admissions, uro reviews and taxi fares for prosthetic pensioners.
• Visit existing high risk/cost and new DRG 1 pensioners as per PMP schedule.
• Organizing uro reviews and capture the uro report.
• Organize prosthetic review clinic and load report on CC2.
• Assist to obtain death certificate and Notification of Death (if available) for deceased pensioners and autopsy reports if available.
• Assist with medical walk-in office clients.
• Capture Medical Reports via scanning in respect of pensioners, chronic medication, and subsequent care and specific medical reports requested.
• Assist with education of pensioners on entitlements.
• Updating DOCR with hospital pensioner admissions and discharges for DRG 1 to 3.
• Weekly/Monthly report of Pensioner URO reviews, home visits and prosthetic reviews and other interventions.
• Manage visa and passport expiry documents of SCI pensioners in Hospital.
• Managing and control of medical expenses as per yearly plan
• Follow up, from RMA system generated reports, high cost claims based on type of injury and estimated costs.

WHAT YOU'LL BRING TO THE TABLE?

• Nursing diploma /degree
• 3  years nursing experience as professional nurse
• Valid Driver’s License
• Own Transport
• Mandatory Travelling for home visits and mobile clinics
• Registration with Nursing Council or relevant Health Professional Council
• Building Customer Loyalty
• Contributing to Team Success
• Managing Work (includes Time Management)
• Stress Tolerance
• Decision Making
• Confidentiality
• Credibility
• Friendly
• Initiative
• Integrity