Senior Officer: Field Case Management X1 at Road Accident Fund

Key Performance Areas

Field Case Management

• Activate an undertaking certificate and compile a case management report.
• Conduct a home visit and educate the claimant on offerings of the undertaking and explain the process to be followed.
• Conduct follow up assessments and make recommendations on claimants needs as per the assessment.
• Coordinate the referrals to service providers aligned to the claimants needs as per the undertaking certificate.
• Ensure successful integration of the claimant back to the family and educate the claimant and family on the condition of the claimant.
• Facilitate timely consultation with appropriate medical service providers.
• Provide vocational guidance and possible back to work opportunities.

Rehabilitation Services

• Monitor the rehabilitation of claimant post discharge.
• Monitor the drug utilisation and application review thereof.
• Assess the level of care giver and the financial implications/ salary thereof. 
• Determine claimant needs and facilitate reasonable recommendations for home and car modifications based on the nature of the claimant’s medical condition.
• Coordination of admission and request the necessary authorisations as per the caregiver SOP and guidelines.
• Coordinate and facilitate transfer to the hospital for admission.
• Facilitate the appointment of caregivers between the claimant and the caregiver, provide guidance on the process. 
• Coordinate the monthly submission of time sheets for payment processing.

Facilitate the accuracy and effective submission of invoices

• Ensure that accounts submitted to the fund from service providers are valid in terms of RAF guidelines and the Road Accident Fund Act.
• Assess and monitor claims invoices to curb over servicing or abuse and fraudulent claims.
• Ensure that the accounts are paid timeously, according to service level agreements.
• Ensure that services and treatments claimed for are accident related (related to the accident under consideration).
• Compare outcomes and cost of different therapeutic modalities and surgical techniques and the information provided is invaluable in developing guidelines for clinical management.

Reporting

• Compile and update Case management reports for the injured.
• Provide a report on patient care and ongoing rehabilitation.
• Reporting on the service by service providers.

Stakeholder management

• Drive the stakeholder interaction needed to facilitate the level of care.
• Maintain relations with different levels of health specialists to enable smooth interactions.
• Particate in the awareness of RAF case management services in the communities.
• Communicate with all levels of stakeholders.
• Participate in relevant external RAF activities and events. 
• Ongoing engagements with service providers.

Qualifications

• Bachelor’s Degree or Advanced Diploma in Nursing/ Allied Health Professions or related qualification.
• Registration with the relevant Health Professional Council body.

Experience

• Relevant 4 years’ experience in the medical environment.
• Experience in Managed Healthcare environment.
• Knowledge of ICD and CPT coding will be an advantage.
• Valid code 8 driving license.