Case Manager Jobs in South Africa at Metropolitan Life Insurance in Cape Town

JOB TITLE: CASE MANAGER HRM (Reference # 8142) Metropolitan Health Job Band:6

Introduction

Exciting opportunities exist for self motivated and driven individuals to take up this challenge.
Reporting to the Health Risk Management Team Leader, you will assist in the enhancement and management of a cost-effective Managed Health Care project with the objective of promoting rational utilisation of Private Hospital facilities and containing associated costs generated by these services.

The Incumbent will be responsible for:

Managing hospital benefits for schemes contracted for Health Risk Management (HRM)
Ensuring members are placed in the appropriate facility for the appropriate treatment
Through concurrent review, identify members in need of case management and refer to Medical Advisers
Liaising and communication verbally and in writing with the Medical Advisers, Consultants,Service Providers, Account Managers, Members, etc
Ensuring requests for Hospital Authorisation fall within the Scheme rules
Retrospectively scrutinising Hospital claims exceeding the authorised amounts
Generally assisting in Health Risk Management Solutions
Handling basic administrative functions
Management of members repeatedly admitted to hospital

The applicant should meet these requirements:

Registration as a registered Nurse (with SANC)
A nursing degree or diploma
A sound knowledge of hospital claims and fees
A minimum of 3 years experience gained in a Private Hospital
Good working knowledge of computer packages (MS Office)
Knowledge and understanding of the following areas will be an advantage:
Experience and exposure in theatre and or ICU

Competencies Required

Excellent communication skills, both verbal and written
Good analytical and problem-solving capabilities
Good planning and prioritising abilities

Additional Information

Shortlisted candidates will be subjected to the following statutory checks:

ITC
Criminal
References
Qualifications

How to apply

Internal applicants:

Sign onto PeopleSoft > Recruiting Activities > Careers

External applicants:

Go to our website

www.mhg.co.za

> Careers at Metropolitan Health> Vacancies

Contact Person:

Noyise Notiki

Telephone:

0214802769

Closing Date:

11 April 2012

Please state clearly for which position you are applying as well as the reference number in all communications. The job grade and remuneration will be commensurate with the successful applicant's experience, qualification and skills.