Pensions Medical Case Auditor – Welkom needed at Rand Mutual

Job title : Pensions Medical Case Auditor – Welkom

Job Location : Free State, Welkom

Deadline : May 12, 2024

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WHAT WILL YOU DO?

  • Monitoring of Hospital Admissions weekly and liaison with Case Managers.
  • Give feedback to Case Managers and other Colleagues of Pensioners admitted in Hospitals and include for hospital utilisation management.
  • Authorization of Pensioners Hospital admissions, Chronic Medications and Sundries, prosthetic repairs and replacement
  • Adjudicate requests for subsequent care and refer to RMA doctor as necessary.
  • Assess and adjudicate medical service provider reports and advise on invoices submitted and captured when requested.
  • Visit medical service providers and hospitals to address Pensioners related issues
  • Organize and attend scheduled clinics.
  • Organize transport for SCI acute admissions, uro reviews and taxi fares for prosthetic pensioners.
  • Visit existing high risk/cost and new DRG 1 pensioners as per PMP schedule.
  • Organizing uro reviews and capture the uro report.
  • Organize prosthetic review clinic and load report on CC2.
  • Assist to obtain death certificate and Notification of Death (if available) for deceased pensioners and autopsy reports if available.
  • Assist with medical walk-in office clients.
  • Capture Medical Reports via scanning in respect of pensioners, chronic medication, and subsequent care and specific medical reports requested.
  • Assist with education of pensioners on entitlements.
  • Updating DOCR with hospital pensioner admissions and discharges for DRG 1 to 3.
  • Weekly/Monthly report of Pensioner URO reviews, home visits and prosthetic reviews and other interventions.
  • Manage visa and passport expiry documents of SCI pensioners in Hospital.
  • Managing and control of medical expenses as per yearly plan
  • Follow up, from RMA system generated reports, high cost claims based on type of injury and estimated costs.

WHAT YOU’LL BRING TO THE TABLE?

  • Nursing diploma /degree
  • 3  years nursing experience as professional nurse
  • Valid Driver’s License
  • Own Transport
  • Mandatory Travelling for home visits and mobile clinics
  • Registration with Nursing Council or relevant Health Professional Council
  • Building Customer Loyalty
  • Contributing to Team Success
  • Managing Work (includes Time Management)
  • Stress Tolerance
  • Decision Making
  • Confidentiality
  • Credibility
  • Friendly
  • Initiative
  • Integrity

How to Apply for this Offer

Interested and Qualified candidates should Click here to Apply Now

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