Road Accident Fund
.
The Road Accident Fund is a state insurer established by statute, it provides insurance cover to all drivers of motor vehicles in South Africa in respect of liability incurred or damage caused as a result of a traffic collision. Liability incurred in relation to property damage (such as damage to vehicles, buildings, vehicle contents) is excluded from cover.
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Senior Officer: Field Case Management
Job Type Contract
Qualification Bachelors , Higher National Certificate , National Certificate
Experience 4 years
Location Western Cape
City Cape Town
Job Field Administration / Secretarial  , Medical / Healthcare 
Key Performance Areas
Decision making regarding quality of care.
Assessment of ongoing medical problems of the injured after discharge in the home environment.
Assessment of patient according to prescribed measurements.
Assessment of burden of care and needs of the client.
Monitors of quality of care issues
Selection and monitoring clinical pathways.
Decision Making regarding collaboration.
Facilitates collaboration of service providers with client.
Protector of privacy and confidentiality.
Coordination of plan of care and services.
Facilitate caregiver’s appointments necessary for the client.
Facilitate timely consultation with appropriate medical service providers.
Facilitate family and clinical team communication.
Health educator and counsellor for client and family.
Utilization review.
Post discharge follow-through.
Decision making regarding advocacy criteria.
Conflict resolution expert and referee.
Liaison between patient and care team.
Negotiating and procuring resources and services from providers.
Benefit analysis.
Record keeping and documentation.
Maintain patient confidentiality.
Decision making regarding resource utilization.
Post discharge follow-through.
Drug utilization review.
Assistive devices necessary for client.
Home alterations.
Vehicle adaptations.
Vocational guidance after life changing event for client.
Placement of children in special schools.
Back to work opportunities.
Decision making regarding legal & ethical criteria.
Advise client of accident relatedness of his claim.
Decide reasonableness and appropriateness of service.
Advise whether altering homes and placing clients in rehab centres or institutions is appropriate.
Advice regarding payment of care givers taking into account patient autonomy, informed choice, medical implications and burden of care.
Pre-authorisation of admissions.
Arrange for hospital admission and advise patients on their benefit.
Assess medical Bills.
Assessment of bills received and advise claimants of outcomes of bill review.
Recommend payment.
Recommend payment of bills assessed.
Qualifications
Bachelor’s degree or Advanced Diploma in Nursing/ Allied Health Professions or related qualification.
Registration with the relevant Health professions council.
Knowledge of ICD and CPT coding will be an advantage.
Valid code 8 driving license.
Experience
Relevant 4 years’ experience in the medical field of which 1 year is on supervisory level.
Experience in Managed health.
Method of Application
Interested and qualified? Go to Road Accident Fund on careers.raf.co.za to apply
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