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 / Degree in Nursing.
• Preferred qualification: Advance certification in Intermediate Coding.
• ICD 10 Code and CPT coding ability and understanding of diagnostic related groupers.

Minimum Experience

• 3-5 years’ experience as a hospital Case Manager.

Added Advantage

• Degree in Nursing.

DELIVERABLES

• 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.
• Investigate and understand Funder, Doctors, Nurses and Patient needs to enable delivery of a quality service.