Hospital Case Manager

Mediclinic Sandton; Randburg; On-site; ZAR 200 000 - 300 000; Full time

Job summary

A healthcare provider in Randburg seeks to hire a Case Manager to coordinate the hospital case management process, govern patient stay, and ensure compliance with medical aid contracts. The ideal candidate must have a clinical qualification, at least 3 years of experience in a clinical role, and a strong understanding of clinical coding and anatomy. Competitive compensation package offered.

Qualifications

• Minimum of 3 years in a clinical role required.
• Experience in Theatre and/or ICU preferred.
• Knowledge of Funder Contracts and medical aid requirements.

Responsibilities

• Coordinate the hospital case management process.
• Communicate with Funders as contractually agreed.
• Ensure compliance with case management procedures.

Skills

Understanding of anatomy

Clinical coding

Computer literacy

Scientific nursing principles

Education

Clinical qualification

Registered Nurse / Professional Nurse

Tools

Microsoft Office

Hospital management systems

Job description

MAIN PURPOSE OF JOB

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