Case Manager

Case Manager - Table View20th June, 2023As the leading medical recruitment agency in South Africa, our client has an exciting opportunity for a Case Manager based in Cape Town (Tableview), South Africa. The Case Manager utilizing clinical knowledge and expertise, mitigates financial risk through comprehensive accurate coding of hospital events; as well as the justification of hospitalization encompassing level of care and length of stay. The Case Manager will be responsible for liaising between the patients, treating clinicians, and managed care organizations to provide an accurate clinical motivation / indication of the patient’s stay in hospital. The Case Manager will also assume responsibility for the application of clinical knowledge in the risk management of patients.Responsibilities : Ensure appropriate, complete and relevant diagnostic and procedural coding of all patient records within the hospital.Application of clinical knowledge for effective ICD 10 and CCSA coding of patient Events.Clinical coding of all patient events with valid ICD 10 and CCSA codes relevant to diagnosis, treatment rendered, and procedures carried out.Review clinical coding during patient stay in hospital.Application of clinical knowledge in the risk management of patients in terms of length of stay, level of care and medical aid benefits available.Monitor and action risk related to medical aid benefits and hospitalization.Provide clinical data to substantiate length of stay and level of care.Accompany Managed Care Organisation Case Managers on ward rounds in the hospital, if required.Ensure correct clinical coding for all patients.Releasing of patient accounts for billing; relating to coding, LOS / LOC to ensure submission of an accurate hospital invoice. Consult with the relevant service providers regarding the patient treatment.Daily clinical rounds to all patients to allow for assessment and evaluation of patients to motivate for LOS, LOC and treatment.Electronic clinical updates to managed care organization / insurance providers, to motivate for patients’ level of care and length of stay in hospital.Final authorisation / releasing of all discharged patient accounts for final billing after reviewing authorisation of length of stay, level of care, and Coding. Monitoring and managing costs effectively for all patients / Risk managementMonitoring the patients in progress report and ensuring that patients ward movements, bed status and level of care on the system is accurate.Facilitate discharge planning and movement of patients to step-down or rehab facility.Assist with case management queries and investigations from funders, doctors and patients.Participate in the transition of care project as per policy.Reviewing and taking action on emails.Capturing of Risk factorsMaintaining patient confidentialityAbility to implement changes effectively.Manage associated administrative tasks.Assist with any other duties assigned by the Billings Manager from time to time.Compliance with all industry relevant legislative acts, regulations and circularsLiaise with a network of internal and external stakeholders.Work effectively and co-operatively with others to establish and maintain good working relationships that are mutually beneficial.Develop collaborative relationships to help accomplish work goals.Effective communication to medical schemes by utilising the rules of engagement published in the Tariff and Billing Guidelines.Effective communication, collaboration and consultation with other role players in the healthcare team.Provide appropriate clinical information to MCOEffective and timeous communication with the members of the fund when appropriate.Identify own training needs and communicate with line manager.Identify own training needs and communicate with line manager.Identify and ensure informal training for all relevant staff related to manage healthcare subject matter.Actively participate as a member of a team to achieve goals.Active involvement in own professional development to maintain a satisfactory level of skill and knowledge.Requirements : B Degree / Diploma Nursing qualification or equivalent NQF level 6 or Enrolled Nursing qualification or equivalent NQF level 4.Qualification in associated Healthcare sciences or Managed care / Case management3 years professional healthcare experience.Intensive Care Nursing experience is beneficialPrevious hospital and medical scheme case management experience is beneficialGeneral administrative skillsComputer literateICD 10 and CCSA coding experience / qualificationSalary is market relatedTo apply, please send your updated CV to Please be advised that you will be contacted by Medipath Healthcare Recruitment within 14 days should we wish to proceed with your application. Similarly, if you are not contacted by Medipath Healthcare Recruitment, please accept your application as unsuccessful. Your CV will automatically be added to our database and we could be contacting you should a suitable position arise.