The Case Manager utilising clinical knowledge and expertise, 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
Requirements:
B Degree/Diploma Nursing qualification and/or Case Management qualification
Diverse clinical nursing experience
Case Management experience
ICD-10 / CPT Coding Qualification or Experience
SAP IS-H experience advantageous
Proficiency in Microsoft Office products
Duties & Responsibilities:
Responsible for application of clinical knowledge in justifying 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, mitigating financial risk and final releasing the cases for billing
Liaise with a network of internal and external stakeholders regarding patient treatment
Adhere to the Managed Health Care rules of engagement
Compliance with all industry relevant legislative acts, regulations and circulars
