Case Manager | Specialised Units

Life Healthcare; Springs; On-site; ZAR 200 000 - 300 000; Full time

Job summary

A healthcare organization in Springs is seeking a Case Manager for Specialised Units. Responsibilities include managing financial and clinical administrative risks and ensuring compliance with healthcare standards. The ideal candidate will have a nursing diploma or degree and be registered with the South African Nursing Council, with strong problem-solving and communication skills. This position is crucial for ensuring operational excellence in the unit.

Qualifications

• Current registration with the South African Nursing Council.
• Understanding of clinical coding and terminology.
• Computer proficiency required.

Responsibilities

• Conducting ward rounds and ensuring accurate data collection.
• Updating clinical information for funders.
• Managing relationships with internal and external stakeholders.

Skills

Problem-solving

Resilience

Verbal & written communication

Influencing

Education

Diploma or degree in Nursing

Job description

Function Nursing Facility Position Case Manager | Specialised Units Introduction

A vacancy exists for a Case Manager Specialised Units, based at Life Springs Parkland Hospital, reporting to Marilyn Daswa, Patient Service Manager. The successful candidate will be responsible for the management of the financial and clinical administrative risks pertaining to patients in specialised units – Intensive care units, high care units and neonatal intensive care units.

Critical Outputs

Ensuring operational excellence by

• Conducting ward rounds and ensuring the accurate complete collection of clinic data from patient files and liaisons with nursing staff and attending clinicians
• Updating accurate clinical information to justify length of stay and level of care to medical funds of specialised unit cases and where operationally required general ward cases.
• Updating and providing the necessary information to funders regarding high value items, limited benefits and protocols as defined by managed care organizations
• Communicating funder requirements / responses to attending clinicians and patients where necessary, and ensuring compliance with industry standards
• Ensuring effective management of real time and manual messaging, including requests, responses, rejections and submissions.
• Ensuring the accurate submission of accounts to funders.
• Complying with governance and risk management requirements by ensuring adherence to patient services policies and procedures
• Ensuring compliance to service level agreements with internal and external stakeholders

Ensuring effective management of revenue by

• Ensuring the accurate and complete coding of patient accounts
• Ensuring the correct application and correct interpretation of funder RSRT contracts and FFS claims
• Reporting RSRT risks identified to the relevant manager

Ensuring effective management of quality outputs by

• Adhering to patient services escalation processes and customer services standards
• Investigating and reporting published alerts incidents and agreeing upon appropriate action with internal and external stakeholders

Ensuring effective management of relationships with internal / external stakeholders by

• Building and maintaining relationships with internal stakeholders
• Providing and facilitating training regarding RSRT contracts
• Providing feedback and information regarding concerns or issues raised by external stakeholders
• Providing feedback on external stakeholders impacting on the efficiency and effectiveness of the case management process
• Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings

Requirements

• Diploma or degree in Nursing, Physiotherapy, Clinical Associates, Paramedics as Critical Care Assistants or Emergency Care Practitioners or any other qualification that covers Anatomy, Physiology, Pathophysiology and Microbiology as foundational courses. Experience including proven leadership, change and people management
• Current registration with the relevant professional / regulatory body (South African Nursing Council)
• Understanding of clinical coding, clinical terminology and anatomy, funder rules, co-payments and exclusions
• Working knowledge of COID
• Understanding of business and change management principles
• Computer proficiency

Competencies

• Problem-solving, analysis and judgement
• Resilience
• Engaging diversity
• Verbal & written communication and presentation
• Influencing
• Drive & energy
• Excellence orientation
• Ethical behaviour
• Building relationships
• Customer responsiveness
• Organisational awareness
• Leading my example (Key for Managers)
• Motivating and developing people (Key for Managers)