Senior Officer: Hospital Case Management X6

The Road Accident Fund’s mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.

Purpose of the job: The Senior Officer: Hospital Case Management is responsible for the coordination of medical care for motor vehicle accident patients/claimants in Hospitals.

Key Performance Areas

Assessment of Injuries

• Assess extent of injuries on admitted patients.
• Daily assessment of patient according to prescribed measurements.
• Conduct daily patient scoring and data collecting.
• Monitor quality of care.
• Select and monitor clinical pathways.
• Identify patients’ needs.
• Identify and record pre-existing conditions.

Facilitate patient care

• Facilitate multi-disciplinary patient care where appropriate.
• Facilitate timely transfers into the appropriate levels of care.
• Coordinate the admission and pre authorisations of the transfers.
• Coordinate and provide necessary health education.
• Discharge planning and vocational guidance for the afterlife changing event for client
• Drug utilization review.

• Proper handover to Field Case Management for continuation of care.

Patient advocacy

• Cost Benefits analysis of the medical services.
• Liaison between patient and care team to ensure common understanding and conflict resolution.
• Negotiate and procure resource services from providers.
• Ensure that patient confidentiality is maintained by all parties.

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 Hospital Case management reports.
• Recommend issuing of Undertaking Certificate.
• Provide a reasonableness report of patient care in preparation of the rehabilitation post discharge.

Stakeholder management

• 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.
• Knowledge of ICD and CPT coding will be an advantage.
• Valid code 8 driving license.

Technical and behavioural competencies required

Behavioural:

• Planning Organising and Coordinating.
• Personal Mastery.
• Judgment and Decision Making.
• Ethics and Values.
• Client Service Orientation.

Technical:

• Core specialities in the case management process.
• Knowledge of healthcare operations.
• Ability to maintain patient confidentiality.
• Full knowledge of medical tariffs, treatment plans.
• Coding standards and protocols.
• Knowledge of PFMA to be able to analyse different requirements as per the claimants.

NB: “RAF offers Total Employment Cost packages with no additional contributions from the Employer; successful candidates are required to structure their packages in a manner that will suit their needs.”

The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.

Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful

Security Vetting shall be conducted on all prospective employees

It is the applicants’ responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.