- Case Management
- Reference Price List Codes (RPL)
- Understanding the body and disease processes for effective management
The Institute of Health Risk Managers (IHRM) offers a short course or an accredited skills programme for case managers and disease managers working in the Road Accident Fund, Workmen’s Compensation, public and private hospitals, medical schemes and managed care industry.
The accredited skills programme carries credits towards the Wealth Management Level 5 qualification.
Case managers are recognised experts and vital participants in the care coordination team. They empower people to understand and access quality, efficient, cost-effective health care.
Case management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and utilisation of available resources to promote quality, cost-effective outcomes. The case managers can be the glue of the healthcare system if their services are utilised appropriately, ensuring that the right patient receives the right treatment at the right place, at the right time, by the right provider at the right cost.
Case management can achieve client wellness and autonomy through advocacy, communication, education, identification of service resources and service facilitation. Case management services are best offered in a climate that allows direct communication between the case manager, the patient, and the healthcare team, in order to optimise the outcome for all concerned.
Case management seeks to achieve that the right patient gets the right treatment at the right place at the right time and at the right cost, achieving holistic patient centred care. Case managers generally have sound clinical knowledge. However to be a successful case manager one now needs to use the clinical knowledge, and add knowledge of the funding environment and the theory of case management to ensure that the right principle is applied.
We have facilitated case management training extensively in both the public and private healthcare sectors – for hospitals and funders. The facilitators of this programme have extensive knowledge and experience in both the clinical and funding environment. Our experience has shown that there is a need for a better understanding of the potential benefits that case managers can bring to the patient, healthcare team and the business if their services are utilised optimally.
- Principles of health risk management including insurance and health economics
- Components of health risk management including health risk assessment, health risk management programmes and health risk funding
- Application of health risk management principles
- Legislative environment (Medical Schemes Act and its Regulations)
- Quality management in health risk management
- Overview of utilisation management
- Utilisation management monitoring – Coding, benchmarks, guidelines and variances
- History and definition of case management
- Standards of case management practice
- The case management process
- Level of case management and discharge planning
- Case manager competencies
- Leadership and communication skills
- Motivational interviewing
- Patient advocacy
- Ethico-legal considerations
The SAQA Accredited Programme
To achieve the credits for this programme, each learner must
- Attend the six-day facilitation – three modules of two days each
- Complete assignments
- Write an exam
Should the learner not successfully complete the assignments or the exam, they will be issued with a certificate of attendance.
Should they successfully complete the entire programme, they will receive an INSETA statement of results, detailing the credits they have achieved against the Wealth Management qualification.
The learner will receive forty-one credits on successful completion of this programme.
The following unit standards will be covered in this module:
This programme is supported by learning resources, reference material and on-line assessments.
The RPL codes is the current procedural coding system published by the South African Medical Association as it applies to medical doctors only. This programme will give the learner an understanding of the:
- Structure of the codes;
- Layout of the codes;
- Rules applicable; and
The programme can be completed as elearning programme. We can also provide the programme as a facilitated one-day online Teams meeting training programme. Email email@example.com for more details
This short course will provide an understanding of the normal functioning of the body, disease processes and conditions that impact on health risk.
- Normal functioning of the body systems and related common diseases and impairments.
- Appropriate health care services including investigations and treatment.
- The main tariff codes, important rules and modifiers.
- Overview of the medical schemes act and how it relates to benefits.
- The entitlement to prescribed minimum benefits for important conditions related to each body system.
- The role of protocols and formularies in the management of risk.
- The importance of coordinated care.
- Case managers
- Disease managers
- Wellness coaches
- Claims assessors
- Cardiovascular system
- Respiratory system
- Reproductive system
- Digestive system
- Urinary system
- Musculo-skeletal system
- Psychological and psychiatric conditions
- Endocrine system
- Nervous system
- RPL codes, rules and modifiers
- Prescribed minimum benefits
- The medical schemes act
- Introduction to managed care
This is offered as a flexible in-house programme with a choice of modules.
Can be delivered as an accredited skills programme towards the SAQA FETC: Medical Claims Assessing qualification.
Email firstname.lastname@example.org for further details.