Hospital Case Manager

Mediclinic; Gauteng; On-site; ZAR 350 000 - 450 000; Full time

Job summary

A prominent healthcare institution in Gauteng is seeking a Case Manager to coordinate the hospital case management process, ensuring compliance and minimising financial risk. The ideal candidate will have a clinical qualification and at least 3 years of experience in a clinical role. This on-site position offers an opportunity to lead the Case Management team and requires strong communication skills with funders.

Qualifications

• Minimum 3 years in a clinical role required.
• Experience in Theatre or ICU is desired.
• Medical aid background preferred.

Responsibilities

• Coordinate hospital case management process.
• Minimise financial risk by managing patient stay.
• Ensure compliance with case management procedures.

Skills

Understanding of anatomy

Computer literacy

Knowledge of medical terminology

Funder Contracts

Clinical coding

Education

Clinical qualification

Registered Nurse / Professional Nurse or qualified Paramedic

Tools

Microsoft Office

B2B or Funder portals

Job description

Mediclinic Sandton | Bryanston, Johannesburg | South Africa Closing date : 17 / 11 / Number of positions : 1 Recruiter name : Nomsa Rachel Somzila Reference number : Workplace Type : On-sitePermanentPlease note if you are an internal employee on a fixed term contract please apply using an external candidate profile and not your employee profile

MAIN PURPOSE OF JOB

To coordinate the hospital case management process and facilitate the communication process between all role players by providing accurate and timous 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 timous finalisation of cases to facilitate reimbursements from funders of claims
• Consistently and timous 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

• Understanding of anatomy; physiology and medical terminology
• Funder Contracts; Medical aid requirements / narrations
• Scientific nursing principles and process
• Authorisation and motivation of Level of Care; Length of Stay; Clinical Coding, high-cost stock, Short Payments etc.
• Use of electronic systems (i.e. B2B or Funder portals) for the purposes of requesting authorisations, performing case management updates and for troubleshooting)
• Computer literacy (Microsoft Office, hospital / practice management systems)
• 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; clinical coding; and case management processes
• Application of clinical codes and finalisation thereof

All applicants will be considered, with the understanding that preference will be given in accordance with the Employment Equity Plan of Mediclinic Southern Africa, as well as internal applicants / employees that meet the minimum requirements.