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Medical Case Manager (Nurse) – Cape Town

Job Overview

More Information

An exciting new position has opened for a Global UK-based medical services company expanding to South Africa. They are looking for qualified and registered nurses, ICU or Trauma(emergency) trained and with preferably an ATLS or equivalent to join their dynamic team.

Key relationships:

Internal and outsource partner Assistance teams, Government department; New Zealand nursing and repatriation co-ordinator teams; HINT assistance co-ordinators; airline employee health teams; overseas medical teams; airline medical clearance departments; suppliers and other departments within the group.

Job profile:

Working as part of the International nursing team, the role includes:

  • the provision of a Monday-Sunday nursing service providing an efficient, cost effective and clinically appropriate service to the company’s clients  (Shift work Mon-Sun between 8am and 10pm)
  • management of all new and ongoing emergency medical assistance, claims and repatriation cases
  • provision of non-diagnostic medical advice directly to policyholders and Medical Helpline clients
  • providing clinical input to the Occupational Health team in the medical assessment of individuals pre-deployment
  • be a point of escalation for any patient, client or provider requiring clinical input
  • provision of emergency airline employee health services
  • checking equipment on return from repatriations and air ambulances and ensuring sufficient supplies are available to manage the repatriation workload
  • provide medical support to the repatriation co-ordinator team

Key responsibilities:

Medical case management

  • Manage a caseload of patients assessing and prioritising each case taking into account: clinical requirements; local facilities; age of patient; country of residence and cost of care
  • Perform telephone medical assessments with treating medical team/review written medical reports and provide clients with a clear assessment and management plan
  • Provide medical support and advice to assistance coordinators as required enabling them to manage cases more effectively
  • Negotiate with treating medical team and assistance co-ordinators to ensure that the needs of the patient are met within the terms of their insurance policy
  • Recognise cases at risk from deterioration and ensure appropriate measures are in place to manage ongoing care
  • Notify duty doctor and duty Team Leader of very ill, very young/old, pregnant patients, patients in high risk countries and cases requiring high cost care in order that management of case may be escalated
  • Identify individuals that may have a relevant past medical history under the terms of their insurance policy and pre-travel medical declaration
  • Participate in conference calls with clients and patients to assist with decision making with regards to repatriation recommendations and fitness to fly
  • Provide advice on cases requiring repatriation or evacuation taking into account: the country of origin and local facilities; due date of return and likelihood of clinical deterioration; medical condition and requirements during travel; safest and most cost effective means of transport; airline medical clearance guidelines and the company’a International repatriation guidelines

Repatriation/evacuation

  • Provide medical support to the repatriation co-ordinators
  • Complete a fit to fly call prior to every repatriation and evacuation unless exceptional circumstance preclude this
  • Liaise with treating medical team overseas, medical escort and patient’s home medical facility to ensure ongoing care is maintained once patient has been repatriated
  • Identify patients requiring intensive care, spinal, haemodialysis or complex care and ensure that hospital admission has been confirmed prior to repatriation
  • Provide clients with air ambulance/repatriation options based on all available information and contractual obligations
  • Liaise directly with suppliers and clients to ensure the safe, efficient transfer of patients
  • Allocate escorts to repatriations taking into account escort availability, experience and client requirements
  • Complete airline Medical Clearance (Medif) forms accurately and ensure appropriate assistance has been requested via the ticketing agent
  • Participate in daily checking of returned medical equipment bags, ensuring sufficient supplies of equipment are available for future repatriations/air ambulances and that the legal requirements of storage and record keeping of controlled drugs are adhered to at all times

International medical claims case management

  • Provide clinical leadership and guidance to the team to ensure members receive timely and accurate cover decisions, allowing them to progress with their treatment.
  • Assess any proposed treatment plans for medical necessity and to ensure they fall within policy terms and conditions
  • Monitor patient progress and liaise with the provider to ensure the member is discharged to an appropriate environment.
  • Ensure that costs remain routine and customary for the care delivered when requested

Occupational Health pre-deployment assessment cases

  • Work closely with the OH team to identify the healthcare risks of individuals, taking into account: age, clinical history, country of deployment, length of deployment and role.
  • Refer high risk cases to the duty doctor for further advice
  • Liaise with the OH team to ensure cases are managed within a timely fashion

Airline employee health service

  • Take first call and initial case details for airline employees and individuals entitled to use the service
  • Formulate a plan of care identifying when a medical assessment is necessary, arranging medical provider, providing guarantee of payment for foreign providers, and liaising with individuals and employers as required
  • Liaise with crew member or other authorised service recipient to determine fitness to fly and suitability to return to work

Medical helpline

  • Provide simple non-diagnostic medical advice to individuals calling the medical helpline advice line
  • Document details of the call on the Helpline Call Logger
  • Escalate calls to appropriate staff if the query is outside your area of expertise

Resource management

  • Show awareness of the budgetary constraints of the role and work with team members, team leaders and operations managers to ensure delivery of a cost effective service
  • Recognise when workload becomes unmanageable and effectively utilise available resources to ensure continuity of case management
  • Assist colleagues to manage workload especially during periods of high activity

Communication

  • At all times act in a professional, polite and courteous manner towards others
  • Ensure written communication is legible, relevant, objective and accurate and in line with NMC guidelines
  • Act as a credible role model
  • Offer support, guidance and advice to team members referring matters to more senior members of staff as appropriate

Policies and governance

  • Comply with all the company’s Group polices and protocols
  • Participate in departmental audits and provide feedback on areas of non compliance

Skills Training and Education

  • Act as a knowledgeable resource with the ability to share information across the team
  • Identify areas of learning opportunities within the team
  • Participate in departmental training programme as directed by line manager

Personal development

  • Be professionally accountable for your own practice and decisions and adhere to the Nursing and Midwifery Council UK Code of Professional Practice
  • Ensure all professional registration requirements are maintained with regards to your own professional development
  • Undertake and participate in your performance review identifying own personal development needs and taking action to achieve new skills and knowledge
  • Act with autonomy within current professional guidelines but recognise your own limitations, seeking advice and assistance where necessary

Requirements

  • Registered ICU/Trauma Nurse prefereably with ATLS
  • Valid Drivers licence
  • Excellent communication skills and fluent in English.

This job description is not exhaustive and may be updated as required to meet changing service demands.

Send your updated CV  to Vicki  at  cv@medicalcareers.co.za

Subject : Case Manager

Whatsapp: 067 912 7966

Only candidates can apply for this job.
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