Case Manager

A vacancy exists for a Case Manager General based at Life Groenkloof Hospital, reporting to Patient Services Manager.

The successful candidate will be responsible for managing the financial and clinical risks of the patient in a general ward by ensuring accurate coding, clinical updates and accounts submissions of patient hospitalization to achieve strategic objectives.

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 hospitalisation; 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

Grade 12
Diploma or degree in Nursing, Physiotherapy, Clinical Associates, Paramedics as Critical Care Assistants or Emergency Care Practitioners or any other qualification that covers Anatomy, Physiology, Pathophysiology and Microbiology as foundational courses.
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

Be able to work and function independently
Pleasant, hardworking and honest personality
Teamwork and dedication
Must be able to work under pressure
Must be able to handle every
situation with a positive attitude
Drive & energy
Strong leadership and trustworthy
Ethical behaviour
Building relationships
Customer responsiveness
Organisational awareness
Team player

Please Send your resume/CV