Case Manager – Hospital Group – Mafikeng Full TimeNEW
Main Purpose of Job:
To deliver an effective case management process and facilitate the communication process between all role-players by providing accurate and timeous clinical information in order to minimize the financial risk for the company
Requirements:
Grade 12
Registered Nurse, currently registered with SANC
Certificate in Coding (advantageous)
3 to 5 years’ experience in a private hospital or medical scheme environment in a Case management capacity
Working knowledge of ICD-10 and CPT codes
Computer proficiency – SAP System or similar
Duties & Responsibilities:
Ensure authorizations on admissions (daily) is accurate as per SAP system
Conduct daily case management rounds in allocated units to obtain updated clinical information from patient files
Comply with case management procedures, Medical Scheme contracts and legal aspects by utilizing available resources and systems (specifically the Case Manager Workstation on SAP)
Communicate consistently and timeously with the Medical Schemes as contractually agreed through the relevant case management channels
Obtain Doctors letters of motivation in support of all cases where Medical Schemes request these from the hospital as part of their assessing process
Minimize financial risk by effectively managing patient stay
Communicate daily statistics with Billings regarding number of files with case management and with Billings, to progress these files through the system as quickly as possible and to achieve the discharge to final bill target
Resolve queries related to short payments by Medical Scheme, in conjunction with the Collections Department
Should you meet the above requirements, we urge you to apply by forwarding your CV along with any supporting documents to tracy@glass-house.co.za
