Hospital Case Manager

Mediclinic George; South Africa; On-site; ZAR 480,000 - 700,000; Full time

Job summary

Mediclinic George is seeking a dedicated Case Management Coordinator to oversee the hospital's case management process, ensuring timely, accurate clinical information to minimise financial risk and optimise funder reimbursements.

This role requires at least three years in a clinical setting, with preference for Theatre/ICU experience, knowledge of patient administration systems, and familiarity with coding standards.

Qualifications

• Minimum of 3 years in a clinical role.
• Experience in Theatre and ICU preferred.
• Background in medical aid or private healthcare advantageous.
• Experience as an ILS/ALS Paramedic desirable.
• Familiarity with case management processes and coding.

Responsibilities

• Minimise financial risk by effectively managing patient stay
• Ensure compliance to case management procedures, contracts and legal aspects
• Ensure finalisation of cases to facilitate funder reimbursements
• Communicate with funders per contract case management channels
• Adhere to Level 3 coding guidelines
• Lead and manage the Case Management team (if applicable)

Skills

Anatomy

Funder contracts

Patient admin programs

Scientific nursing

Computer literacy

Level of Care authorization

Length of Stay

Short payments

Statutory acts

Patient confidentiality

Visitation policies

Daily workflow

Clinical coding

Education

Clinical qualification

Registered Nurse

Professional Nurse

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

• Anatomy (including terminology)
• Funder Contracts; Medical aid requirements/narrations
• Patient admin programmes on the AS400 system
• Scientific nursing principles and process
• Computer literate (Microsoft Office)
• Authorisation and motivation of Level of Care; Length of Stay; Short Payments etc.
• 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; coding; and case management processes
• Application of clinical codes and finalisation thereof