Hospital Case Manager

joint-medical-holdings; KwaZulu-Natal; On-site; ZAR 320,000 - 480,000; Full time

Job summary

Joint Medical Holdings is seeking a Case Manager to advocate for patients, optimize resources, and promote positive outcomes within a multidisciplinary hospital setting in KwaZulu-Natal.

You will ensure ICD-10/CCSA coding accuracy, manage billing processes, liaise with medical aids, doctors and patients, and contribute to timely case reviews while adhering to policy SLAs and Care Risk Management procedures.

Qualifications

• Must hold Nursing Qualification with registration with the SANC.
• 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 liaising with medical aids, doctors, and patients.

Responsibilities

• Adhering to policy and SLAs for clinical updates.
• Ensure precise ICD-10/CCSA coding.
• Meet month-end deadlines.
• Verify accurate and complete billing.
• Communicate with medical schemes.
• Manage DSO and optimize tools.
• Oversee rollout and adherence to Care Risk Management.
• Resolve rejections related to case management.
• Foster teamwork, communication and professional growth.
• Stay updated on industry trends and regulations.

Skills

ICD-10/CCSA coding

Computer literacy

Billing / Auditing experience

Education

Nursing qualification with Registration with the SANC

Job description

PURPOSE OF POSITION

As a Case Manager, you will advocate for patients, optimize healthcare resources, and promote positive outcomes. Your expertise will streamline processes, enhance patient satisfaction, and contribute to the overall effectiveness of JMH healthcare delivery system.

KEY PERFORMANCE AREAS

• 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.
• 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.

COMPETENCIES (The following will be advantageous)

MINIMUM REQUIREMENTS

• Relevant Nursing Qualification withRegistration with the SANC
• 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.