Summary
The Case Manager will be responsible for the liaison between the patient and medical aids in order to secure payment for the hospital.
Requirements
Grade 12 or equivalent NQF level 4 qualification
Diploma in Nursing is essential
Work Experience
Previous Case Management experience advantageous
Intermediate computer skills (Excel and Word)
Excellent Interpersonal and communication skills
Knowledge of Medical Aids
ICD & CPT Coding would be advantageous
Knowledge
Ensure all the relevant details on Hospital Billing System are updated and are accurate
Supply all details regarding patients' history to Clinical partners
Monitor and control costs for Managed Care Organisation patients
Confirm length of stay for all Managed Care Organisations patients
Accompany Managed Care Organisation Case Managers on ward rounds in the hospital
Assist with final authorisation of Managed Care patient files
Ensure correct coding for all Managed Care Organisation patients
Consult with the relevant service providers regarding patient care treatment
Assist with the transfer of patients to Rehab Hospital or step down facilities
Arrange in-service training for relevant staff to meet the needs of the theatre department
Liaise network of internal and external stakeholders to ensure that managed care of patients is maintained
Actively participate as a member of a team to achieve goals
Active involvement in own professional development to maintain a satisfactory level of skill and knowledge
Work effectively and co-operatively with others to establish and maintain good working relationships that are mutually beneficial
Develop collaborative relationships to help accomplish work goals