Hospital Care Coordinator

Kaelo; Johannesburg; On-site; ZAR 30 000 - 60 000; Full time

Job summary

An established industry player is seeking a dedicated Hospital Care Coordinator to oversee patient care from admission to discharge. This role involves coordinating hospital cases, ensuring optimal benefit utilization, and advocating for patients. The ideal candidate will possess a nursing degree, with at least two years of case management experience, and be knowledgeable in clinical coding and healthcare regulations. Join a dynamic team focused on delivering high-quality patient care while utilizing evidence-based guidelines and maintaining compliance with policies. This is an exciting opportunity to make a significant impact in the healthcare sector.

Qualifications

• Minimum 2 years of hospital case management experience required.
• Understanding of healthcare regulations and strong analytical skills.

Responsibilities

• Coordinate care for all hospital admitted patients.
• Ensure correct benefit utilization and allocate appropriate care levels.

Skills

Clinical Decision-Making

Effective Communication

Organizational Skills

Resilience

Education

Registered Nurse

Degree / Diploma in Nursing

Tools

ICD Coding

CPT Coding

DRGs Knowledge

Health Risk Assessment

Job description

Hospital Care Coordinators are responsible for end-to-end oversight of all in-hospital cases for Kaelo clients. This includes management and coordination of care from patient admission through discharge planning. They are expected to provide daily authorization updates to ensure optimal patient care at the most effective cost. Communication with patients and providers regarding benefit availability, limitations, and review of appropriate care levels is essential.

This position reports to the Clinical Operations Manager and is supervised by the Clinical / Medical Advisor.

Note : This job specification outlines the general responsibilities and qualifications expected of a Hospital Care Coordinator. Specific duties may vary depending on the organization.

Responsibilities include :

• Receive handover on cases admitted / authorized by the Acute Care Coordinators.
• Coordinate care for all hospital admitted patients.
• Ensure correct benefit utilization by members.
• Identify exclusions from the onset of treatment requests.
• Allocate the correct level of care to appropriate facilities.
• Review appliances used in hospital against current treatment guidelines.
• Provide information about treatment options, side effects, and possible complications of medications or procedures.
• Discuss diagnoses with doctors, specialists, and healthcare providers.
• Assess patient needs such as mental health or substance abuse issues and refer to EAP if applicable.
• Ensure service level agreements are met.
• Use the latest evidence-based guidelines for patient management.
• Develop referral and treatment protocols for new or updated conditions.
• Report clinical escalations or concerns to the Clinical Review Committee.
• Act as a patient advocate.
• Maintain confidentiality of clinical information.
• Assist with monthly reporting, including statistics and savings.

Key outcomes :

Effectively utilize resources and guidelines to assess, prioritize, advise, and manage admitted patients, ensuring thorough documentation and compliance with policies.

• Maintain current nursing skills through workshops, seminars, and professional development.

Qualifications :

REQUIRED

• Registered Nurse
• Degree / Diploma in Nursing
• ICU / Theatre trained
• Minimum 2 years hospital case management experience
• Medical Aid or Insurance industry knowledge
• Knowledge of ICD, CPT coding, and DRGs

DESIRED EXPERIENCE :

• Experience in managed healthcare and hospital case management
• Understanding of healthcare regulations and standards
• Strong analytical and clinical decision-making skills
• Effective communication with multidisciplinary teams

Technical Skills :

REQUIRED

• Understanding of clinical codes
• Health risk assessment knowledge
• Computer literacy

Personal Attributes :

• Accountability and ethical conduct
• Effective communication and documentation skills
• Organizational and planning skills
• Resilience and adaptability
• Self-development orientation

Remote Work :

Employment Type : [Specify if needed]

Key Skills :

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