Title Procedure Pathway Case Manager
Categories Gauteng
Salary Negotiable
Location Johannesburg, Northern Suburbs
Job Information

Managed Care Organisation has an opening for an experienced Ophthalmic Nurse or Orthopaedic Nurse for a Case Manager position to establish a new pathway and aims to manage and implement an operational plan for efficient and cost-effective patient care services. The successful candidate will have the opportunity to help launch and shape this pathway.


Qualifications, Experience and Knowledge:
Qualification in Nursing – Diploma, BA(Cur), Registered with SANC.
Qualification and Experience in Theatre is essential
Speciality Training/Qualification and Experience a ward would be an advantage.
2-5 years Ophthalmic or Orthopaedic Nurse experience is essential.
Experience in practice management will be an advantage.
Experience in managing patient care activities in a medical practice or hospital facility.
Exposure to medical billing and prothesis management
Excellent communication skills to promote effective interactions with all stakeholders, i.e., surgeons, patients, staff, and the public.

Knowledge of Afrikaans (spoken and written) will be an advantage.

Key Accountabilities:
Customer Relationship Management
Induction of surgeons and their rooms regarding the ICPS pathway and clinical guideline protocols.
Development and training of ICPS Network surgeons and their administrators in the use of the ICPS website registration process.
Funder relations regarding scheme queries, member queries, carve- outs in adverse events.
Attend to queries from Suppliers, Funder and Members.
Marketing the ICPS pathway to non-network surgeons and their administrators.
Marketing the ICPS pathway to patients requiring cataract surgery.
Schedule and conducting six monthly or yearly visits to practices.
Induction of ICPS processes to hospitals and hospital patient administrators.
Measuring, monitoring, and managing compliance to the ICPS pathway.
Maintain a provider and supplier contact list and address book.
Liaise and manage prosthesis ordering, supply, and billing.
Establish a relationship with suppliers of services.

Clinical Data Management:
Assisting with clinical systems development
Manage the quality of the data captured on the ICPS registration system.
Providing quarterly clinical governance reports to the board
Data collecting and root cause analysis of adverse events, complications and carve out cases.

Clinical Case Management:
Managing the authorisation of surgery
Confirmation of admission and discharge dates of patients
Monitoring in-hospital stay (clinical update via email) and managing service level agreement violations.

Cost Management:
Review supplier bills for accuracy of charges and unusual item utilisation.
Measuring and reporting on billing and utilisation trends.
Managing the relationship and cost profile with MMED

Please email your CV to maropeng@etalyons.co.za and if you do not hear from us within 2 weeks, please consider your application unsuccessful.

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