Sophisticated private hospital, located in Southern Suburbs, is seeking a Case Manager to join the billings team.
The successful candidate will be responsible for case management of the hospital for ICU, NICU and PICU patients.

Key Responsibilities:

• Ensure accurate collection of clinical data by conducting ward rounds, liaising with nursing staff & attending clinicians & assessing patient files
• Update accurate clinical information to justify the length of stay (LOS) and level of care (LOC) to medical aid funds and their assigned managed care organisations.
• Update and provide the necessary information to funders regarding HV (high value) items, limited benefits and protocols as defined by managed care organisations.
• Communicate funder requirements/responses to attending clinicians and patients where necessary, and ensure compliance with industry standards.
• Ensure effective management of real-time and manual messaging, including requests, responses, rejections and submissions.
• Foster and maintain healthy relationships with internal stakeholders. E.g. nursing, pharmacy and business hubs.

Benefits:

• Excellent training & development opportunities within this Private Hospital Group
• Offers great benefits such as Medical Aid, Provident Fund and 13th Cheque.

Key Requirements:

• Must be registered with SANC as a Registered Nurse, preferably with ICU or NICU experience.
• Must have knowledge of hospital group’s policies, practices, systems and procedures.
• Must have knowledge of the hospital group’s billing methods including the FFS document and RSRT contracts would be advantageous
• Need to be a self-motivated, confident and energetic individual with natural leadership ability.
• Must be goal oriented and target driven, with the ability to take initiative and exercise sound judgment and decision making.