Hospital Case Manager

Mediclinic Emfuleni; Vanderbijlpark; On-site; ZAR 300,000 - 550,000; Full time

Job summary

A leading healthcare facility in Vanderbijlpark seeks a Case Manager to oversee hospital case management processes, ensuring compliance with regulations and effective patient administration. The role requires strong clinical knowledge and experience, with responsibilities including financial risk management and communication with funders. Ideal candidates are Registered Nurses or qualified Paramedics with at least three years in a clinical setting.

Qualifications

• Minimum of 3 years in a clinical role required.
• Experience in Theatre or ICU desired.
• Medical aid background beneficial.

Responsibilities

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

Skills

Anatomy

Physiology

Scientific nursing principles

Patient administration policies

Education

Registered Nurse / Professional Nurse

Qualified Paramedic

Job description

To coordinate the hospital case management process and facilitate communication among all role players by providing accurate and timely clinical information to minimize the financial risk for the organization.

KEY RESPONSIBILITY AREAS

Minimize financial risk by effectively managing patient stay

Ensure compliance with case management procedures, contracts, and legal aspects by utilizing available resources and systems.

Ensure correct and timely finalization of cases to facilitate reimbursements from funders.

Consistently and promptly communicate with funders as contractually agreed through the relevant case management channels.

Ensure adherence to clinical coding standards as per Level 3 coding guidelines.

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 as an ILS / ALS Paramedic.

REQUIRED JOB SKILLS AND KNOWLEDGE

• Anatomy, physiology, and terminology
• Funder contracts; Medical aid requirements/narrations
• Scientific nursing principles and processes
• B2B EMS (electronic message system): check status of authorizations and troubleshoot
• Authorization 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 deviations; coding; and case management processes
• Application of clinical codes and finalization thereof (Level 3 coding)
• Patient admin programs on the AS400 system