Case Manager

JOB SUMMARY

To plan, coordinate and execute case management work at hospital level. The incumbent utilises clinical knowledge to minimise financial risk and ensure accurate billing through comprehensive accurate coding of patient care.

REQUIREMENTS

Minimum Requirements:

• Diploma in General Nursing.

Minimum Experience:

• 3-5 years’ experience as a hospital case manager
• Knowledge of private health care operations

Added Advantage:

• Advance Certification in Intermediate coding
• Degree: Nursing

Key Competencies:

• Computer literacy
• IDC and CPT coding
• Coding standards and protocols
• Understanding of diagnostic related groupers

DELIVERABLES

• To Liaise with Receptionist for authorisations
• Ensure compliance to case management procedures, standards and protocols
• Plan, coordinate and execute Clinical coding in accordance with relevant CHG standards and protocols
• Ensure accurate, appropriate and complete diagnostic and procedural coding of all patient records in the hospital
• Timeously and consistently communicate and follow up with Funders (Medical Aids, COID, Government, RAF, DOL, etc.)
• Provide appropriate clinical information to Funders in order to update Length of Stay, Level of Care, formulary utilisation, assistive devices / Prosthesis, diagnostic interventions, therapy intervention and procedural interventions and required change in the facility.
• Consult daily with all relevant health care providers with regards to patient treatment
• Ensure the maintenance of patients’ clinical status (subsequent interventions and treatments) in accordance to Funder requirements for the duration of hospitalisation
• Ensure the correct categorisation and management of different patient accounts to facilitate reimbursement by Funders
• Ensure accurate and timeous finalisation of cases to facilitate reimbursement by Funders
• Minimise financial risk by the effective management of patient hospitalisation
• Follow the established and approved escalation processes in the event of a decline of payment by Funders
• Ensure to remain in the group and facility targets of 3 days for WIP (work in progress) and DNYB (discharged not yet billed)