We are looking for an In-Hospital Case Manager.
Purpose of the Job
The Case Manager provides hospital utilisation management, education/training, and other clinically based activities as assigned, to coordinate care between the medical Fund/managed care organisation, members, providers and the community.
Duties and Responsibilities
- Verifies eligibility of cover in accordance with medical fund membership files and medical fund rules.
- Facilitates admission of the members 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 practitioners 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 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.
Required profile for job ad : In-Hospital Case Manager - Windhoek
Experience and Qualifications Required
- A clinical degree or diploma recognised by the Health Professions Council of Namibia.
- An additional clinical qualification and /or experience in an operating theatre or ICU would be an advantage
- Minimum of 2 – 3 years’ experience in case management within a medical fund, 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.
Skills and Competencies Required
- Strong verbal and written communications skills.
- Customer service focus.
- Ability to solve problems in a customer friendly manner.
- Understanding of the Namibia healthcare industry and Prescribed minimum benefit legislation.
- Understanding and the use of medical fund / healthcare financing terminology.
Computer Literacy
- Proficiency with the following programmes is required:
- MS Word
- MS Excel
- MS Outlook / email
- MS Explorer / Internet
- Some prior knowledge/experience in the use of a medical aid administration or managed care system.
Registration Requirements
- Current and continued registration with the Nursing Council of Namibia and or the applicable Health Professions Council of Namibia.
Work Requirements
- The position is based in Namibia
- Own transport is essential
- Willingness to work long hours when required is a requirement.
Language Requirements
- English: Primary business language. Be able to speak, write, spell, read and comprehend the language
- Being able to speak, write, spell, read and comprehend in other languages would be an advantage.
Remuneration
- A competitive salary and benefits will be negotiated, consistent with experience and the role and responsibilities of the position.
