A vacancy exists for a Case Manager, General Units, based at Life Vincent Pallotti Hospital, reporting to the Patient Services Manager, Ester van der Walt. The successful candidate will be responsible for the management of the financial and clinical administrative risks pertaining to patients in the General Units.

 

Critical Outputs

Ensuring the maximisation 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 funders of general ward cases and where operationally required specialised unit cases.

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

 

Requirements

 

Nursing Qualification, preferably Professional Nurse with at least three years’ experience or Enrolled Nurse with proven case manager and clinical coding experience of at least 3 -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

 

Attention to detail

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