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Senior Officer : Field Case Management - East London
Road Accident FundEast London, ZA25 days ago
Job descriptionActivate 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. 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. 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. 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. 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. Bachelor’s Degree or Advanced Diploma in Nursing / Allied Health Professions or related qualification. Registration with the relevant Health Professional Council body. 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. Insurance jobs
Job title : Senior Officer : Field Case Management - East London
Job Location : Eastern Cape, East London
Deadline : October 18, 2025
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Key Performance Areas
Field Case Management
Rehabilitation Services
Facilitate the accuracy and effective submission of invoices
Reporting
Stakeholder management
Qualifications
Experience
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Senior Officer Field • East London, ZA
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