Quality Control Case Manager (Hospital Group) – Lenasia, Johannesburg

Job Description

Requirements:

B Degree Nursing Qualification or equivalent NQF level 6
5 years Case management experience in a multi-disciplinary hospital
ICU / High Care nursing experience
ICD-10 / CPT Coding Qualification or Experience
SAP IS-H experience advantageous
Proficiency in Microsoft Office products
SAP Experience
Good communication skills
Good customer responsiveness
Good time management skills
Need to be able to work under pressure

The main purpose of this position:

The incumbent will be responsible for ensuring efficient processes with the requisite quality oversight, as well as general management of the Case management department

Duties & Responsibilities:

Responsible for the management of a complex department
Liaise with a network of internal and external stakeholders
Effective query and complaint resolution
Adhere to the NHN Managed Health Care rules of engagement
Compliance with all industry relevant legislative acts, regulations and circulars
Oversight and accountability for case management and confirmations functions, including but not limited to:

Monitor and action risks related to medical aid benefits and hospitalisation
Ensure optimal confirmations function including escalations
Continuous quality assessment of clinical updates
Ensure accurate, specific and comprehensive clinical coding
Case management updates are within the industry turnaround time
Evaluation and coaching/training where needed
Co-responsible with Billing Manager to maintain DNYB of 5 days