Hospital Case Manager

Mediclinic Milnerton; Milnerton; On-site; ZAR 200,000 - 300,000; Full time

Job summary

A leading hospital in South Africa is seeking a Case Manager to coordinate the case management process and communicate with funders. The ideal candidate will have a clinical qualification and at least 3 years of experience in a clinical role, with preferred experience in Theatre or ICU. This position offers an opportunity to minimize financial risk for the organization while ensuring quality patient care.

Qualifications

• Minimum of 3 years in a clinical role.
• Experience in Theatre and or ICU preferred.
• Medical aid background and experience in private healthcare desired.

Responsibilities

• Coordinate hospital case management processes.
• Ensure compliance with case management procedures.
• Communicate with Funders regarding case management.

Skills

Understanding of anatomy

Medical aid requirements

Scientific nursing principles

Use of electronic systems

Computer literacy

Patient Administration policies

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

• 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