Hospital Case Manager

Mediclinic is an international private healthcare services group, founded in South Africa in 1983, with divisions in Switzerland, Southern Africa (South Africa and Namibia) and the United Arab Emirates. The Group is focused on providing specialist-orientated, multidisciplinary services across the continuum of care in such a way that the Group will be regarded as the most respected and trusted provider of healthcare services by patients, medical practitioners, funders and regulators of healthcare in each of its markets.

MAIN PURPOSE OF JOB

To coordinate the hospital case management process and facilitate the communication process between all role players by providing accurate and timeous clinical information to minimise the financial risk for the organisation.KEY RESPONSIBILITY AREAS Minimise financial risk by effectively managing patient stay Ensure compliance to case management procedures, contracts and legal aspects by utilising available resources and systems Ensure correct and timeous finalisation of cases to facilitate reimbursements from funders of claims Consistently and timeously communicate with Funders as contractually agreed through the relevant case management channels Ensure clinical coding standards are adhered to as per Level 3 coding guideline Lead and manage the people in the Case Management team (if applicable)REQUIRED EDUCATION ESSENTIAL EDUCATION: Clinical qualification DESIRED EDUCATION: Registered Nurse / Professional Nurse or qualified ParamedicREQUIRED EXPERIENCE ESSENTIAL MINIMUM EXPERIENCE: Minimum of 3 years in a clinical role DESIRED EXPERIENCE: Experience in Theatre and or ICU; Medical aid background; Experience in private healthcare environment or experience as an ILS/ALS ParamedicREQUIRED JOB SKILLS AND KNOWLEDGE

• Understanding of anatomy; physiology and medical terminology
• Funder Contracts; Medical aid requirements/narrations
• Scientific nursing principles and process
• Authorisation and motivation of Level of Care; Length of Stay; Clinical Coding, high-cost stock, Short Payments etc.
• Use of electronic systems (i.e. B2B or Funder portals) for the purposes of requesting authorisations, performing case management updates and for troubleshooting)
• Computer literacy (Microsoft Office, hospital/practice management systems)
• Relevant aspects of applicable statutory acts (e.g. Consumer Protection Act; PMB; etc.)
• Patient Administration policies and procedures (e.g. Patient Confidentiality; Visitation of external case managers; etc.)
• Daily workflow; managing deviances; clinical coding; and case management processes
• Application of clinical codes and finalisation thereof