CASE MANAGER - TEAM LEADER

Joint Medical Holdings Ltd.; Durban; On-site; ZAR 550,000 - 850,000; Full time

Job summary

Joint Medical Holdings Ltd. seeks a Case Manager Team Leader to oversee communication among patients, physicians, and medical insurers, upholding the JMH tariff agreement and applying clinical expertise to manage risk related to length of stay and level of care.

You will supervise case management activities, ensure timely updates, accurate ICD 10/CCSA coding, and reliable billing, while guiding a multidisciplinary team to maintain high standards of care coordination.

Qualifications

• Registration with the SANC as an RN
• Must be computer literate
• Billing / Auditing experience will be advantageous
• Experience in a multidisciplinary hospital environment
• ICD 10 and CCSA coding experience is a requirement
• Must have experience in liaising with medical aids, doctors, and patients

Responsibilities

• Adhering to JMH policy regarding clinical updates within specified turnaround times and service level agreements
• Ensuring precise and comprehensive ICD 10/CCSA coding
• Meeting month-end deadlines
• Verifying accurate and complete billing
• Communicating adequate and pertinent information to medical schemes
• Managing internal DSO and optimizing utilized tools
• Overseeing the complete rollout and adherence to Care Risk Management Procedures and Protocols
• Effectively resolving rejections related to case management
• Supervising all Case Management staff
• Leading and guiding a team of case managers, offering direction and assistance to maintain the highest standards of care coordination
• Cultivating a collaborative and supportive workplace atmosphere, encouraging teamwork, communication, and professional growth among team members
• Keeping abreast of industry trends, regulations, and best practices in case management, ensuring compliance with relevant standards and guidelines

Job description

About the job CASE MANAGER - TEAM LEADER

The Case Manager Team Leader will oversee communication among patients, physicians, and medical insurers to uphold the agreement between the funder and the JMH Group as outlined in the JMH Group Tariff Interpretation Document. Additionally, they will apply clinical expertise in managing patient risk related to length of stay, level of care, and available medical benefits, while also supervising case management activities.

• Adhering to JMH policy regarding clinical updates within specified turnaround times and service level agreements.
• Ensuring precise and comprehensive ICD 10/CCSA coding.
• Meeting month-end deadlines.
• Verifying accurate and complete billing.
• Communicating adequate and pertinent information to medical schemes.
• Managing internal DSO and optimizing utilized tools.
• Overseeing the complete rollout and adherence to Care Risk Management Procedures and Protocols.
• Effectively resolving rejections related to case management.
• Supervising all Case Management staff.
• Leading and guiding a team of case managers, offering direction and assistance to maintain the highest standards of care coordination.
• Cultivating a collaborative and supportive workplace atmosphere, encouraging teamwork, communication, and professional growth among team members.
• Keeping abreast of industry trends, regulations, and best practices in case management, ensuring compliance with relevant standards and guidelines.

MINIMUM REQUIREMENTS

• Registration with the SANC as an RN
• Must be computer literate.
• Must have Billing / Auditing experience will be advantageous.
• Experience in a multidisciplinary hospital environment.
• ICD 10 and CCSA coding experience is a requirement.
• Must have experience in liaising with medical aids, doctors, and patients.