Case Manager

Introduction

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.

Duties & Responsibilities

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

Desired Experience & Qualification

ESSENTIAL QUALIFICATIONS INCLUDE:

· Case Management qualification AN ADDED ADVANTAGE

· Case Management experience

· ICD-10 / CPT Coding Qualification And/or Experience

· Clinic Manager Software experience advantageous

· Proficiency in Microsoft Office products