Case Manager

Clinix Health Group (Pty) Ltd; Soweto; On-site; ZAR 300 000 - 600 000; Full time

Job summary

An established industry player is seeking a dedicated Case Manager to oversee hospital case management processes. This role involves ensuring compliance with clinical coding standards, liaising with healthcare providers, and managing patient accounts effectively to minimize financial risks. The ideal candidate will have a strong nursing background, relevant coding certifications, and experience in hospital settings. Join a dynamic team committed to providing exceptional patient care while navigating the complexities of healthcare funding and reimbursement processes. This is an exciting opportunity to make a significant impact in a vital role within the healthcare sector.

Qualifications

• 3-5 years’ experience as a hospital case manager.
• Relevant qualifications in nursing and coding are essential.

Responsibilities

• Ensure compliance with case management procedures and standards.
• Coordinate clinical coding and maintain accurate patient records.
• Communicate effectively with funders regarding patient care.

Skills

ICD coding

CPO coding

Clinical coding

Communication skills

Patient management

Education

Relevant Nursing qualification

Anatomy and physiology course certification

Job description

Job title: Case Manager

Job Location: Gauteng, Soweto
Deadline: May 03, 2025

Minimum Requirements:

• Relevant Nursing qualification.
• CM or Billings Clerk with ICD training and anatomy and physiology course certification.
• IDC and CPO coding.
• 3-5 years’ experience as a hospital case manager.

Responsibilities:

• Liaise with Receptionist for authorisations.
• Ensure compliance to case management procedures, standards and protocols.
• Plan, coordinate and execute Clinical coding in accordance with relevant CHG standards and protocols.
• Ensure accurate, appropriate and complete diagnostic and procedural coding of all patient records in the hospital.
• Timeously and consistently communicate and follow up with Funders (Medical Aids, COID, Government, RAF, DOL, etc.).
• Provide appropriate clinical information to Funders in order to update Length of Stay, Level of Care, formulary utilisation, assistive devices / Prosthesis, diagnostic interventions, therapy intervention and procedural interventions and required change in the facility.
• Consult daily with all relevant health care providers with regards to patient treatment.
• Ensure the maintenance of patients’ clinical status (subsequent interventions and treatments) in accordance to Funder requirements for the duration of hospitalisation.
• Ensure the correct categorisation and management of different patient accounts to facilitate reimbursement by Funder.
• Ensure accurate and timeous finalisation of cases to facilitate reimbursement by Funders.
• Minimise financial risk by the effective management of patient hospitalisation.
• Follow the established and approved escalation processes in the event of a decline of payment by Funder.
• Ensure to remain in the group and facility targets of 3 days for WIP (work in progress) and DNYB (discharged not yet billed).