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