Case Manager – Hospital Group (Durban) 13 views
Job Overview
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.
Job Description
- 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
Minimum 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 is advantageous
- Proficiency in Microsoft Office products
