Clinical Case Manager – Africa Health Care Head Office at Africa Health Care

Critical Outputs


Review clinical coding in accordance with CPT and ICD requirements at group level
Ensure that pre-admission and pre-authorisation processes are maintained
Maintain patients' clinical status in accordance with funder approval requirements for the duration of hospitalization; keeping patients administration teams informed and managing the entire hospital stays' financial risk in support of the Group Patient Administration and Billings Manager
Ensure Group Clinical updates are submitted timeously as per group tracker
Provide Training on ICD/CPD Coding
Ensure group LOC/LOS parameters are maintained
DRG Tracking implementation
Ensure the adherence of hospital staff to funder rules and coding procedures
Keep well informed on legislation pertaining to funders and related Health Care matters


Requirements


Candidates who are registered with SANC as a Registered Nurse or Enrolled Nurse, registered with SAPC as a Pharmacist, registered with the HPCSA as an ALS or ACLS.
High school matric certificate
5+ years' experience of basic finance and Medical Aid administration procedures
Knowledge of hospital billing and tariffs
Have sound computer literacy skills and working knowledge of MS office, word and excel.
Excellent communication skills and the ability to form and build strong partnerships
Excellent negotiation skills & the ability to interact with tact and diplomacy


Competencies


Collaboration/ Relationship Building
Problem-solving, analysis and judgement
Resilience
Engaging diversity
Verbal & written communication and presentation skills
Influencing
Customer responsiveness
Organisational awareness
Excellence and quality orientation
Ethical behaviour
Departments
Admin
Nursing