Case Manager (Hospital Group) – Lenasia, Johannesburg

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Job Description


Nursing or Case Management qualification/experience
Clinical Nursing/ Managed Healthcare experience
ICD-10 / CPT Coding qualification or experience
SAP IS-H experience advantageous
Proficiency in Microsoft Office products

Case Management experience:

Non-Clinical or Assistant Case Manager

The main purpose of this position:

The Case Manager utilising clinical knowledge, experience and patient acuity scoring tools, mitigates financial risk through comprehensive and accurate coding of hospital events

Communication with funders on justification for hospitalisation level of care and length of stay in hospital

Duties & Responsibilities:

Conducting ward rounds on identified patients to obtain clinical information from the patient files
Liaising with Nursing staff, Doctors and Fund Case Managers
Responsible for substantiating patient hospitalisation in terms of treatment, length of stay and level of care
Monitor and action risk related to medical aid benefits and hospitalisation
Ensure accurate, specific and comprehensive clinical coding
Timeous, effective communication and follow up with medical aids
Review authorisation aspects approved and escalate when necessary
Audit LOS/LOC and release the case for billing
Effective communication to medical schemes and adhering to the standards contained in the NHN Managed Health Care rules of engagement
Compliance with all industry relevant legislative acts, regulations and circulars