Case Manager (Spinal Programme Management
Core
Manage access, clinical appropriateness, and risk for spinal surgery, scans, and back/neck pain management requests for medical scheme beneficiaries.
Role type
Case Manager (Spinal Programme Management)
Builds
Healthcare service access and risk management for medical scheme clients
Domain
South African Healthcare / Medical Schemes / Spinal Care
Deliverable
client delivery
Required skills
Clinical knowledge of hospital admissions, LOS, and LOC; Knowledge of South African healthcare legislation and coding (ICD10, CPT4, NRPL, PMB); Holistic patient management; Portfolio case management; Value-based care understanding
Preferred skills
Orthopaedic or Surgical theatre/ward experience; MIP Application System experience
Technologies
MS Office Suite, MS Excel, MIP Application System
Responsibilities
Manage requests for spinal services and scans; Propose treatment alternatives including conservative options; Participate in clinical review of exceptional cases; Engage with treating providers, hospital case managers, and medical advisors
Seniority
Mid-level, hands-on IC
