Hospital Case Manager

Mediclinic Bloemfontein; Bloemfontein; On-site; ZAR 300,000 - 450,000; Full time

Job summary

A leading healthcare provider in Bloemfontein seeks a Case Manager to coordinate hospital case management, improve financial risk management, and ensure compliance. Candidates should have a clinical qualification and a minimum of 3 years experience in a clinical role. Experience in Theatre or ICU is desirable. This role provides an excellent opportunity to contribute to patient care in a private healthcare environment.

Qualifications

• Minimum of 3 years in a clinical role.
• Experience in Theatre and or ICU; Medical aid background.
• Experience in private healthcare or as an ILS / ALS Paramedic.

Responsibilities

• Coordinate the hospital case management process.
• Ensure compliance to case management procedures.
• Manage and communicate with Funders as contractually agreed.

Skills

Anatomy (including terminology)

Computer literate (Microsoft Office)

Patient admin programmes on the AS400 system

Scientific nursing principles and process

Education

Clinical qualification

Registered Nurse / Professional Nurse or qualified Paramedic

Job description

MAIN PURPOSE OF JOB

To coordinate the hospital case management process and facilitate the communication process between all role players by providing accurate and timeous clinical information to minimise the financial risk for the organisation.

KEY RESPONSIBILITY AREAS

Minimise financial risk by effectively managing patient stay

Ensure compliance to case management procedures, contracts and legal aspects by utilising available resources and systems

Ensure correct and timeous finalisation of cases to facilitate reimbursements from funders of claims

Consistently and timeously communicate with Funders as contractually agreed through the relevant case management channels

Ensure clinical coding standards are adhered to as per Level 3 coding guideline

Lead and manage the people in the Case Management team (if applicable)

REQUIRED EDUCATION

ESSENTIAL EDUCATION : Clinical qualification

DESIRED EDUCATION : Registered Nurse / Professional Nurse or qualified Paramedic

REQUIRED EXPERIENCE

ESSENTIAL MINIMUM EXPERIENCE : Minimum of 3 years in a clinical role

DESIRED EXPERIENCE : Experience in Theatre and or ICU; Medical aid background; Experience in private healthcare environment or experience as an ILS / ALS Paramedic

REQUIRED JOB SKILLS AND KNOWLEDGE

• Anatomy (including terminology)
• Funder Contracts; Medical aid requirements / narrations
• Patient admin programmes on the AS400 system
• Scientific nursing principles and process
• Computer literate (Microsoft Office)
• Authorisation and motivation of Level of Care; Length of Stay; Short Payments etc.
• Relevant aspects of applicable statutory acts (e.g. Consumer Protection Act; PMB; etc.)
• Patient Administration policies and procedures (e.g. Patient Confidentiality; Visitation of external case managers; etc.)
• Daily workflow; managing deviances; coding; and case management processes
• Application of clinical codes and finalisation thereof (Level 3 coding)