Company:
Road Accident Fund
Industry: Government
Deadline: Not specified
Job Type: Full Time
Qualification: Bachelors, Higher National Certificate, National Certificate
Experience: 4 years
Province: Limpopo
City:
Field: Medical / Healthcare
Key Perfromance 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 the 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 and possible back to work opportunities.
Rehabilitation Services
- Monitor the rehabilitation of claimant post discharge.
- Monitor the drug utilisation and application review thereof.
- Assess the level of care giver and the financial implications/ salary thereof.
- Determine claimant needs and facilitate reasonable recommendations for home and car modifications based on the nature of the claimant’s medical condition.
- Coordination of admission and request the necessary authorisations as per the caregiver SOP and guidelines.
- Coordinate and facilitate transfer to the hospital for admission.
- Facilitate the appointment of caregivers between the claimant and the caregiver, provide guidance on the process.
- Coordinate 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 specialists to enable smooth interactions.
- Particate 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 Professions or related qualification.
- Registration with the relevant Health Professions Council body.
Experience
- Relevant 4 years’ experience in the Medical environment.
- Experience in Managed Healthcare environment.
- Knowledge of ICD and CPT coding will be an advantage.
- Valid code 8 driving license.
Method of Application
Submit your CV and Application on Company Website:
