B Degree Nursing Qualification or equivalent NQF level 6
1-2 years’ experience in an administrative role or auditing
Advanced computer literacy
The main purpose of this position:
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
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 case for billing
Liaise with a network of internal and external stakeholders regarding patient treatment
Adhere to the NHN Managed Health Care rules of engagement
Compliance with all industry relevant legislative acts, regulations and circulars
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
