Case Manager

at Life Fourways Hospital
Location Johannesburg, Johannesburg, South Africa
Date Posted
Category Management
Job Type FULL_TIME
Work Hours Day
Salary Units MONTH
Currency ZAR

Description

 

A vacancy exists for a Case Manager General based at Life Fourways Hospital reporting to the Patient Services Manager, Thea van Reenen. The successful candidate will be responsible for the financial and clinical administrative risks pertaining to patients and units. This person will be responsible to effectively communicate and deliver an uncompromising quality of service to all internal and external customers by ensuring that all clinical updates and coding are of the highest standard.

 

Critical Outputs

Ensuring the maximization of revenue by

 

Ensuring accuracy of coding

Ensuring the correct application and interpretation of RSRT’s

Participating in meetings and reporting losses to RSRT team and recommend corrective

actions

Monitoring insurance verification and workflow processes

Ensuring effective management of quality outputs by

 

Performing quality walkabouts and implement corrective measures

Implementing and monitoring quality improvement programmes

Adhering to patient services escalation processes in order to achieve QMS targets

Monitoring Q-evaluator scores and implementing corrective measures

Investigating internal and external stakeholder complaints

Ensuring the adherence to customer service standards

Ensuring operational excellence by

 

Monitoring submission of accurate accounts to funders

Updating length of stay and level of care to medical aids

Releasing care risk targets and submission within two days of discharge

Ensuring the compliance to LHC policies and managing authorisations and claim

submissions, rejections and delays

Ensuring governance and risk management by monitoring and adhering to patient

services policies and procedures

Ensuring compliance to service level agreements with internal and external stakeholders

Ensuring all billing checks are closed by the relevant function areas

Ensuring effective management of relationships with internal/external stakeholders by

 

Building and maintaining relationships with internal stakeholders

Providing feedback and information on concerns or issues raised by internal stakeholders

Providing and facilitating training regarding RSRT contracts to the relevant internal stakeholders

Ensuring effective communication with external stakeholders

Managing escalated concerns from Case Managers with external stakeholders

Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings

Carrying out Clinical coding in accordance with CPT and ICD requirements and as per LHC standards.

Maintaining patients’ clinical status in accordance with funder approval requirements for the duration of hospitilisation; keeping patients informed and managing the entire hospital stay’s financial risk

Provide complete and accurate updates and discharge information

Maintaining accurate accounts of all admissions

Improving on short payments and losses

Timeous electronic submission of accounts

Handling patient files in accordance with hospital procedures

Ensuring the adherence of hospital staff to funder rules and coding procedures

Must be willing to work flexi hours including weekends and public holidays as required operationally by the business

Keep well-informed on legislation pertaining to funders and related Health Care matters

 

Requirements

 

Nursing Qualification, Professional Nurse with at least three years’ experience or Enrolled

Nurse or suitable medical qualification with proven case manager and clinical coding

experience of at least 2 -5 years.

Current SANC registration

Knowledge of hospital patient services and case management processes

Knowledge and understanding of CPT & ICD coding

Knowledge of Funder contracts, scheme rules, exclusions and benefits

Understanding of private hospital industry and practices

Computer proficiency

 

Competencies

 

Problem-solving, analysis and judgement

Resilience

Engaging diversity

Verbal & written communication skills

Professional and technical proficiency

Building relationships

Customer responsiveness

Organisational awareness

Influencing skills

Action orientation

Excellence orientation

Ethical behaviour

 

Interested candidates can send their CV

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