Nombuso Mbotho

My role was to ensure the provision of holistic treatment of the Oncology patient, including out-of-hospital management of Oncology benefits .

Liaising with Oncologists by acting as a source of information, in relation to the scheme protocols.

I Promoted rational utilization of Oncology benefits without compromising the quality of health delivery to the member.

Duties and Responsibilities

• Planning, developing, assessing, and evaluating care provided to members. Developing and maintaining case management policies and procedures.

• Ensuring successful & smooth Pre-Authorisation and case management process telephonically and on email.

• Coordinating the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning.

• Consulting with Medical Advisor and external Physicians, health care providers regarding continued care/treatment or hospitalisation.

• Maintaining professional ethics and conduct with patients providers and families

• Ensuring adherence to Scheme Rules.

• Effective handling of Internal/External Clinical Queries Communicate with patients and service providers in order to oncology treatment requests.
• Daily workflow; managing deviances; coding; and case management processes
• Ensuring all cases are within TAT and meeting SLA .

Ref :Cecilia Strauss -012 3342357 (HR)

Ref :Yolande Ellis -083 2587556 (SCM/TL)

• Applying of clinical knowledge in the risk management of patients in terms of length of stay, level of care and medical aid benefits available.
• Provide appropriate clinical information and updates to Medical aids.
• Code for patients according to ICD10 and CPT4 codes standards
• Accompany Managed Care Organisation Case Managers on ward rounds.
• Assist with final authorisation of patient files.
• Control costs for patients.
• Consulted with all service suppliers regarding treatment and phone for patients Facilitate with the transfer of patients to rehab and step-down facilities Update all relevant details on Adclin info Supply all details regarding patient’s history, etc ,clinical partners.
• Daily liaison and communication with Medical Schemes, Hospital Nursing staff and medical practitioners
• Assist at stock take Risk management MHC variance checks Adhoc duties

References :

Dumisile Mkwanazi- 060 5493121,
SCM
Xolani Mndebele -072 7764198

Billings Manager

• I enhanced the quality of patient management, maximize satisfaction and promote cost effectiveness
• Coordinated and provided care that is safe, timely, effective, efficient, equitable, and client-centred.
• Facilitated multiple care aspects.
• Developed effective working relations and cooperate with medical team throughout the entire case management process.
• Promoted quality and cost-effective interventions and outcomes Adhere to professional standards as outlined by protocols, rules and regulations.

References :

Cheryl Naick, Med Scheme, 011 671
4046, Team Leader (Polmed
Business Unit)

• Provided critical care to premature and sick neonates .
• Ensure the highest quality of services is provided Doctors and patients.
• Working with newborn infants born with a variety of problems ranging from prematurity, birth defects, infection, cardiac malformations, and surgical problems.
• Administering IV medications ,bloods ,oral medication.
• Monitoring vital signs and adverse reactions from treatment.
• Ensured smooth running of the Nurses’ station Continual Doctor liaison and inter-departmental relationships
• Ensure all documentation required is correctly completed and appropriately filed and distributed .
• Giving support and health education to the parents and family .

Sr. I.Lesejane

011 495 5123 / 060 980 0478

Shift Leader