Senior Officer: Field Case Management X2

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: Field Case Management is responsible for driving the rehabilitation and health care needs of the injured.

NB: Please note the two positions are based in the following remote areas Pietermaritzburg, Vryheid and Nqutu (Indicate the area of preference when applying the position)

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 utilization 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 authorizations 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.
• Patriciate 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 and Experience  

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

• Valid Code 8 Drivers License.
• Relevant 4 years’ experience in the medical environment.

Behavioral competencies

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

Technical Competencies

• Core specialties 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 analyze different requirements as per the claimants

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.