Hospital Case Manager: Clinician Lead for Reimbursements

Mediclinic; George; On-site; ZAR 300,000 - 460,000; Full time

Job summary

Mediclinic George in George, South Africa seeks an experienced case management coordinator to optimise the hospital's case workflow and facilitate timely communication among clinicians, funders, and administration. You will ensure accurate clinical information, adherence to coding guidelines, and support the team to minimise financial risk and secure reimbursements.

The role requires nursing or clinical qualifications and several years of clinical experience.

Qualifications

• Essential clinical qualification and regulatory compliance knowledge.
• Nursing registration or paramedic qualification preferred for improved scope.
• Experience with funder contracts and medical aid narrations.

Responsibilities

• 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).

Skills

Anatomy terminology

Funder contracts

Patient admin programmes AS400

Scientific nursing principles

Microsoft Office

Authorization of Level of Care

Length of Stay

Short payments

Consumer protection act

Patient confidentiality policies

Education

Clinical qualification

Registered Nurse / Professional Nurse or qualified Paramedic

Tools

AS400 system

Microsoft Office

Job description

Mediclinic George in George, South Africa seeks an experienced case management coordinator to optimise the hospital's case workflow and facilitate timely communication among clinicians, funders, and administration. You will ensure accurate clinical information, adherence to coding guidelines, and support the team to minimise financial risk and secure reimbursements.

The role requires nursing or clinical qualifications and several years of clinical experience.