Busisiwe Sontshete
Specialised Health Care Coach (Case Manager)
About
Dedicated healthcare professional with 10+ years of experience in clinical nursing, case management, and health insurance administration. Skilled in leading multidisciplinary teams, optimizing patient care, and implementing cost-effective healthcare solutions. Proven ability to improve operational efficiency, patient outcomes, and compliance with healthcare regulations.
Experience
Specialised Health Care Coach (Case Manager) - Momentum Group
(2022-05)
- Coordinate post-hospital care and educate members on healthcare benefits.
- Authorize cost-effective surgical and medical care.
- Resolve escalated queries efficiently, ensuring timely follow-up and documentation.
- Communicate with providers to improve healthcare cost efficiency.
- Promote adherence to policies, procedures, and service standards.
Case Manager - GetSavvi Health Medical Insurance
(2021-08 - 2022-04)
- Managed hospital pre-authorizations, guarantees of payment, and after-hours support.
- Conducted telephonic assessments, case management, and follow-ups to prevent readmissions.
- Monitored high-cost cases and liaised with providers for optimal patient outcomes.
- Maintained compliance with company policies, POPI regulations, and SOPs.
Case Manager (Medical Advisor) - Medscheme GEMS
(2020-01 - 2021-07)
- Ensured clinical approval and cost-effective management of treatment plans.
- Monitored operational performance, escalated unresolved issues, and contributed to cost-saving initiatives.
- Maintained compliance with legal, statutory, and regulatory standards.
Prospective Reviewer - Medscheme Bonitas
(2017-09 - 2019-12)
- Managed hospital benefit authorizations and quality assurance for claims.
- Provided analysis, reporting, and customer service for hospital cases.
- Collaborated with multi-disciplinary teams to ensure accurate service delivery.
Professional Nurse - Netcare N1 City Private Hospital - Paediatric High Care & NICU
(2016-11 - 2017-08)
- Managed patient care, medication administration, and monitoring in NICU and PICU.
- Led shifts, delegated duties, and maintained accurate records.
- Educated and supported parents for improved patient outcomes.
- Coordinated with MDT (doctors, physiotherapists, dieticians, and social workers) to ensure holistic patient care.
Professional Nurse - Red Cross War Memorial Children's Hospital - Paediatric Intensive Care Unit
(2014-01 - 2016-10)
- Oversaw medication management, staff allocation, and patient documentation.
- Participated in multidisciplinary decision-making and quality improvement.
- Provided emotional and educational support to families.
Community Service Practitioner - Tygerberg Hospital
(2013-01 - 2013-12)
- Rotated across burns unit, surgical ward, labour ward, operating theatre, and paediatric ward.
- Supervised junior staff and ensured infection control.
- Maintained equipment readiness and accurate patient documentation.
Education
BTech - Occupational Health Nursing - CPUT (2015 - 2016)
Diploma - Nursing Sciences - CPUT (2009 - 2012)
Matric - Ncuncuzo S.S.S. (2006 - 2008)
