In Hospital Case Manager

Introduction

Main Focus Areas

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

Key Performance Areas: (include but are not limited to)

• 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

Post Requirements: (include but are not limited to)

• Registered with SANC – as a Registered Nurse / Enrolled Nurse
• 4 - 5 years’ working with finance and Medical Aid Administration IN A HOSPITAL ENVIRONMENT
• Experience working within a Hospital as a Case Manager
• Advanced Computer Literacy
• Clinical coding knowledge, ICD , CPT coding
• Knowledge of clinical terminology and anatomy, funder rules, co-payments and exclusions

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