Case Manager

Startek is global provider of customer support services, business process outsourcing (BPO), engagement solutions, integrating digital technologies, communication, and data to serve brands worldwide. Our mission is to combine people, technology and data to deliver customer experience excellence for leading brands.

We are currently hiring on behalf of one of our clients within the health administration sector. Should your profile be a direct match for our vacancy. Please do apply.

Should you be in the market for vacancies within the health administration or managed care space and do not see a vacant role within your specialization, please email ***email_hidden*** and include your specialization in the email subject title.

The Case Manager provides hospital utilisation management, education/training, and other clinically based activities as assigned, to coordinate care between the medical scheme/managed care organisation, members, providers and the community.

Duties and Responsibilities

• Verifies eligibility of cover in accordance with medical scheme membership files and medical scheme rules.
• Facilitates admission of the member to a suitable facility.
• Establishes whether or not the member has any co-morbid conditions.
• Communicates with the admitting facility to establish the clinical status of the patient.
• Communicates updates of level of care, length of stay and value to the hospital subject to the clinical guidelines and protocols of the company.
• Communicates with attending medical practitioner to request specific health information to provide an update of a member’s healthcare status.
• Collaborates on a member’s care plan in conjunction with other health professionals such as the Medical Advisor, other Case Management nurses within the organisation, dieticians, podiatrists, optometrists, behavioural health specialists, etc, as the case may be.
• Collaborates with the treating doctor to facilitate a discharge plan for the member.
• Arranges for the member to be transferred to an alternative facility when ongoing care is required.
• Refers patients to Disease Management, where appropriate, during a hospital admission.
• Updates the computer system with the member’s clinical and demographic details.
• Visits high cost members in hospital as required.
• Prepares, participates in discussions and presents cases at clinical meetings.
• Prepares reports and case summaries as needed.
• Completes special assignments and projects instrumental to the function of the department.
• Performs other duties as needed.

• A clinical degree or diploma recognised by either the HPCSA or the South African Nursing Council
• An additional clinical qualification and /or experience in an operating theatre or ICU would be an advantage
• Minimum of 2 years’ experience in case management within a medical scheme, hospital or any other managed care environment.
• Experience with quality management, medical records reviews, case management within a hospital environment and/or primary care case management will be an advantage.
• Experience with chronic illnesses and targeted disease states.
• Strong verbal and written communications skills.
• Customer service focus.
• Ability to solve problems in a customer friendly manner.
• Understanding of the SA healthcare industry and Prescribed minimum benefit legislation.
• Understanding and the use of medical scheme / healthcare financing terminology.
• Registration Requirements
• Current and continued registration with the accredited professional body to which the clinical qualifications are aligned