Case Manager (Hospital Group) – Berea, Kwa-Zulu Natal 194 views
Job Overview
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
- Proficiency in Microsoft Office
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 NHN Managed Health Care rules of engagement
- Compliance with all industry legislative acts, regulations and circulars
