NYOTA SEDIBENG
Case Manager
Pretoria
Summary
I have a passion for helping others and have always been driven to provide the highest quality of care to my patients and members having worked on both in hospital and the medical aids. My communication and interpersonal skills allow me to build strong relationships with patients and healthcare professionals
Overview
16
16
years of professional experience
3
3
Languages
Work History
Clinical case manager
Medihelp- Brooklyn
04.2023 - 01.2025
- Case management of authorised cases according to the acceptable Scheme rules and protocols using the CAM system
- To reduce the risk associated with hospitalization and to provide an effective and unique managed healthcare and management of high cost cases
- Loading telephonic requests directly onto CAM with a pending status, requesting the relevant outstanding documentation.
- Following up on authorised hospital-, stepdown-, rehabilitation- or home nursing cases on a weekly basis by looking for updates and/or phoning the service provider
Clinical consultant
PPSHA (profmed) Centurion
09.2017 - 07.2022
- Ensuring successful & smooth pre-authorisation and case management process telephonically in a call centre environment, on email and online chat using Medcap and MIP system
- Ensure adherence to scheme rules on all Hospital authorisations and clinical updates.
- Ensure correct allocation of facilities for their members.
- Effective handling of internal/external clinical queries.
- Communicate with members and service providers in order to address hospital utilisation matters.
- Assist with Health Risk Management monitoring & management of hospital re-admissions
- Compile & submit detailed reports to the Scheme on costs and patient’s progress.
- Review request for prescribed minimum benefits of scans, hospital admissions as well in rooms procedures
Hospital case manager
Mediclinic midstream -Centurion (ICU/Highcare)
11.2015 - 04.2017
- Coding of all patients records with ICD 10 code and CCSA/CPT coding
- Facilitation admission and discharge processes of patients
- Ensuring the care and discharge plans meet the physical, social, and emotional needs of patients
- Provide appropriate clinical information to medical aids and follow-up with them
- Effectively communicating with other role players in the healthcare team
Personal Healthcare Coordinator
Agility Global Health Solution
10.2014 - 11.2015
- Ensuring service level agreements are met and exceeded
- Managing quality and cost of clinical
- Provide appropriate clinical information to to member and services providers according to the option member as chosen
- To reduce the risk associated with hospitalization and to provide an effective and unique managed healthcare cost per beneficiary
- Delivering a cost-effective Managed Healthcare service. To deliver affordable Managed Healthcare services and effective Customer Service delivery.
Registered nurse and enrolled nurse
Life healthcare Wilgers hospital
07.2009 - 04.2014
- Responsible for overseeing the unit
- Patient Care
- Management of medication
- Shift rosters and supervision of staff
Education
No Degree - NIMART
AQuaH Training School
Johannesburg 04.2001 -
Diploma - general nursing
Life healthcare college
03.2013
Certificate - enrolled nurse
Thuto bopelo nursing college
01.2009
Matric - undefined
Kuschke Agricultural high school
11.2004
No Degree - Intergrated Case Management And ICD 10 Coding
Foundation For Professional Development
Pretoria East 04.2001 -
Skills
Adaptability
References
Esther Baloyi Team leader Medihelp 0723577410
Beverly, Baloyi, Coach, PPSHA 0723678204,
Mrs Elzma Van Zyl from Mediclinic Midstream-Patient service manager 0126529000/9019
Mrs Emma Otanga from Life wilgers -RN 0644229911
Miss Cecila Ntuli from Life wilgers -RN 083467203
Current
November 2024: currently studying for my diploma in healthcare coaching with HCA
Timeline
Clinical case manager
Medihelp- Brooklyn
04.2023 - 01.2025
Clinical consultant
PPSHA (profmed) Centurion
09.2017 - 07.2022
Hospital case manager
Mediclinic midstream -Centurion (ICU/Highcare)
11.2015 - 04.2017
Personal Healthcare Coordinator
Agility Global Health Solution
10.2014 - 11.2015
Registered nurse and enrolled nurse
Life healthcare Wilgers hospital
07.2009 - 04.2014
No Degree - NIMART
AQuaH Training School
04.2001 -
No Degree - Intergrated Case Management And ICD 10 Coding
Foundation For Professional Development
04.2001 -
Diploma - general nursing
Life healthcare college
Certificate - enrolled nurse
Thuto bopelo nursing college
Matric - undefined
Kuschke Agricultural high school
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