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Senior Officer : Hospital Case Management (Tembisa Hospital / Thelle Mogoerane Hospital)

Road Accident FundZA

7 days ago

Job description

Job title : Senior Officer : Hospital Case Management (Tembisa Hospital / Thelle Mogoerane Hospital)

Job Location : Gauteng,

Deadline : October 22, 2025

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Key Performance Areas

Assessment Of Injuries

Assess extent of injuries on admitted patients.

Daily assessment of patient according to prescribed measurements.

Conduct daily patient scoring and data collecting.

Monitor quality of care.

Select and monitor clinical pathways.

Identify patients' needs.

Identify and record pre-existing conditions.

Facilitate Patient Care

Facilitate multi-disciplinary patient care where appropriate.

Facilitate timely transfers into the appropriate levels of care.

Coordinate the admission and pre authorisations of the transfers.

Coordinate and provide neccessary health education.

Discharge planning and vocational guidance for the afterlife changing event for client.

Drug utilization review.

Proper handover to Field Case Management for continuation of care.

Patient Advocacy

Cost Benefits analysis of the medical services.

Liason between patient and care team to ensure common understanding and conflict resolution.

Negotiate and procure resource services from providers.

Ensure that patient confidentiality is maintained by all parties.

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 Hospital Case Management reports.

Recommend issuing of Undertaking Certificate.

Provide a reasonableness report of patient care in preparation of the rehabilitation post discharge.

Stakeholder Management

Communicate with all levels of stakeholders.

Participate in relevant external RAF activities and events

Ongoing engagements with service providers.

Qualifications

Bachelor's Degree / Advanced Diploma in Nursing / Allied Health Professions or related qualification

Registration with the relevant Health Professional Council body

Experience

Relevant 4 years' experience in the Medical environment.

Experience in Managed Healthcare.

Knowledge of ICD and CPT coding will be an advantage.

Valid code 08 driving license.

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Senior Hospital Case • ZA

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