Case Manager (Spinal Programme Management) - Nurse

As the leading medical recruitment agency in South Africa, our client has an exciting opportunity for a Case Manager (Spinal Programme Management) based in Pretoria, South Africa. The Case Manager (Spinal Programme Management) is to actively manage the access, clinical appropriateness and risk (both financial and clinical) of all requests for services pertaining

to back and neck pain management, spinal surgery, scans and associated healthcare services in accordance with the relevant scheme rules, clinical protocols and funding guidelines. To critically consider and propose relevant treatment alternatives that include, but are not limited to, conservative treatment options like physiotherapy. To participate in the clinical review of

exceptional cases and to engage with various stakeholders including treating providers, hospital case managers, medical advisors and colleagues.

Responsibilities

• Support the Medical Advisor and action all requests made by him/ her.
• Take guidance and instruction from the Medical Advisor.
• Integrate skills and knowledge of pathophysiology, epidemiology, clinical management, and patient self-management to holistically review healthcare service and/ or authorisation requests received within the Spinal Management Programme.
• Critically review procedural clinical coding and prosthesis quotations received with requests for spinal surgery.
• Actively engage both beneficiaries and healthcare service providers
• Case management of hospitalized patients
• Discharge planning
• Follow up on active cases with service providers relating to funding levels and updates (daily)
• Interpretation of medical reports
• Clinical decision making
• Perform comprehensive assessments for each patient and facilitate/ perform follow-up in accordance with the schedule determined/ agreed.
• Document all individual contacts and outcomes data in accordance with the guidelines in a timely manner.
• Call and written contact with Members and Providers
• Prepare reports/ case studies as required.
• Performs other duties as assigned within the Managed Healthcare environment

Requirements:

• Registered Nurse with valid registration with SANC
• Knowledge of ICD10s, CPT4, NRPL, PMB conditions and clinical protocols
• Experience within Orthopaedic and/ or Surgical theatre and wards
• Knowledge of Neuro, Orthopaedic and Spinal surgery
• MS Office Suite (intermediate) required.
• MIP Application System experience will be advantageous.
• Reporting - MS Excel (intermediate) required (will be tested)

Salary is market related (includes benefits like medical scheme, provident fund etc)

Location: Pretoria

To apply, please send your updated CV to apply@medipath.co.za

Please be advised that you will be contacted by Medipath Healthcare Recruitment within 14 days should we wish to proceed with your application. Similarly, if you are not contacted by Medipath Healthcare Recruitment, please accept your application as unsuccessful. Your CV will automatically be added to our database and we could be contacting you should a suitable position arise.