Hospital Case Manager

Mediclinic Bloemfontein; Bloemfontein; On-site; ZAR 300,000 - 500,000; Full time

Job summary

A leading healthcare provider in Bloemfontein is seeking a Case Manager to oversee the hospital case management process. The role involves minimizing financial risks, ensuring compliance with procedures, and managing communications with funders. Ideal candidates will have a nursing or paramedic background and at least three years of clinical experience.

Qualifications

• Minimum of 3 years in a clinical role.
• Experience in Theatre and/or ICU preferred.

Responsibilities

• Coordinate hospital case management process.
• Ensure compliance with case management procedures.
• Manage the Case Management team.

Skills

Anatomy

Patient admin programs

Scientific nursing principles

Authorization and motivation

Patient Administration policies

Education

Registered Nurse

Professional Nurse

Qualified Paramedic

Job description

The job description is generally well-structured and informative, but it can benefit from improved formatting for readability and clarity. Minor adjustments include consistent use of HTML tags, better separation of sections, and clearer emphasis on key responsibilities and requirements.

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Job Purpose

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

Key Responsibility Areas

1. Minimize financial risk by effectively managing patient stay
2. Ensure compliance with case management procedures, contracts, and legal aspects by utilizing available resources and systems
3. Ensure correct and timely finalization of cases to facilitate reimbursements from funders
4. Consistently and promptly communicate with funders as contractually agreed through relevant case management channels
5. Ensure adherence to clinical coding standards as per Level 3 coding guidelines
6. Lead and manage the Case Management team (if applicable)

Required Education

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 as an ILS / ALS Paramedic

Required Job Skills and Knowledge

• Anatomy (including terminology)
• Funder Contracts; Medical aid requirements/narrations
• Patient admin programs on the AS400 system
• Scientific nursing principles and processes
• Authorization 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 deviations; coding; and case management processes
• Application and finalization of clinical codes (Level 3 coding)