Senior Officer: Field Case Management x4

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 to driving the rehabilitation and health care needs of the injured.

Note: This is a 12 Month Fixed Term Contract.

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 about the overall 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 after life changing event for client and possible back to work opportunities

Rehabilitation Services

• Monitor the rehabilitation of the claimant post discharge

• Monitor the drug utilisation and application review therof

• Assess the level of care giver and the financial implications /salary therof 

• Determine claimant needs and facilitate reasonable recommendations for home and car modifications based on the nature of the claimant's medical condition 

• Co-ordination of admission and request the necessary authorisations as per the caregiver SOP and guidelines

• Co-ordinate and faciltate transfer to the hospital for admission

• Facilitate the appointment of caregivers between the claimant and the caregiver, provide guidance on the process

• Co-ordinate 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 specialst to enable smooth interactions 

• Participate 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

• Bachelor's Degree or Advanced Diploma in  Nursing/Allied Health Prefessions or related qualification

• Registration with the relevant Health Professions Council.

Experience

• Relevant 4 years’ experience in the Medical environment.

• Experience in Managed Healthcare environment.

• Valid code 8 driving license.

Behavioral Competencies

• Planning, Organizing and Coordinating

• Personal Mastery

• Judgement and Decision Making

• Ethics and Values

• Client Service Orientation

Technical Competencies

• Knowledge of ICD and CPT coding will be an advantage.

• 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.