Hospital Case Manager

Mediclinic Sandton; Randburg; On-site; ZAR 400,000 - 600,000; Full time

Job summary

A leading healthcare organization is seeking a Case Manager to coordinate hospital case management processes. The role focuses on minimizing financial risks linked to patient stays, ensuring compliance with legal aspects and actively communicating with funders. The ideal candidate is a Registered Nurse or qualified Paramedic with a minimum of 3 years clinical experience, preferably in a healthcare environment.

Qualifications

• Minimum of 3 years of experience in a clinical role required.
• Desired background in Theatre, ICU, or as an ILS/ALS Paramedic.
• Understanding of funder contracts and medical aid requirements.

Responsibilities

• Manage patient stay to minimize financial risk.
• Ensure compliance with case management procedures and legal aspects.
• Lead and manage the Case Management team.

Skills

Understanding of anatomy

Medical terminology

Scientific nursing principles

Clinical Coding

Patient Administration policies

Education

Registered Nurse

Professional Nurse

Paramedic

Tools

Electronic systems (e.g. B2B portals)

Job description

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

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)
• 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