FEM is looking to appoint an IOD Case Manager in Head Office. Reporting to the Medical Services Manager.  The overall objective of the position is to oversee other case managers while also liaising with medical service providers to ensure optimum cost-effective treatments without compromising the customer or injured employee. 

The successful candidate will be responsible for inter alia: 

• Facilitating patient/client care by assessing patient/client needs, evaluating treatment options by frequent engagements within multidisciplinary teams and Health Care Facilities.
• Improving clinical outcomes, meeting patient/client healthcare requirements, increasing patient/client satisfaction, and promoting cost-effective healthcare for FEM injured workers in acute and subacute facilities.
• Providing efficient follow up, updating plans and reviewing the progress of cases.
• Liaising with hospitals and doctors to ensure optimum cost-effective treatment as well as monitoring overservicing without compromising the customer or injured employee through effective case management in compliance with the COID Act

This position is aimed at a dynamic and performance driven individual who can deliver administrative outputs whilst working effectively with people. The successful candidate will apply their clinical knowledge in the risk management of patients in terms of length of stay, level of care and other benefits in terms of the COID Act/gazettes and other relevant guidelines. Furthermore, they will monitor high cost and high acumen (ICU/HC) claims of hospital admissions and escalated queries as well as provide pre-authorisation of procedures not covered by the COID Act. 

The minimum requirements of the position are a relevant B-degree / diploma with active registration as a Registered Nurse with SANC. The candidate must have at least 2 years' experience post qualification experience in ICU or Theatre Techniques, with at least 5 years’ experience in Managed care and 3 years in COIDA administration. Good functional computer literacy, good literacy and numeracy skills, an excellent performance track record as well as extensive knowledge of hospital billing rules, industry tariffs (including ICD10 Codes, UPFS, CPT4 Coding, SEP, NAP and PMB’s). Coupled with the above, a valid driver’s license and own transport are part of our minimum requirements. 

Experience in a private hospital managed healthcare environment and knowledge of the COID Act and workman's compensation will be a distinct advantage. Excellent customer focus, the ability to work in a highly pressurised environment, quality orientation, reliability and excellent communication complete our requirements. 

We have offices regionally in Cape Town, Durban and Johannesburg.  Our Head Office is based in Rosebank Johannesburg.

In exchange for the candidate’s successful services, FEM offers a competitive total cost to company remuneration with good benefits. 

Candidates are invited to submit a detailed CV by close of business on the 19 January 2025.  

Applications may not be considered if the minimum criteria of the position are not met. People with disabilities are welcome to apply. FEM promotes the principles of Employment Equity and the appointment of this candidate is at FEM's sole discretion.