Overview

CASE MANAGER:

RESPONSIBILITIES:

To monitor all aspects of patients who are admitted under a Managed Care Limitation and through the co-ordination and liaison with the Doctors, Managed Care Organization and Hospital Nursing staff, ensures that the treatment provided meets the requirements of the Managed Care Organization.
Liaise with Doctors regarding their patients’ progress in cases where the prognosis may indicate that the costs may exceed limitations imposed.
Develop a strong relationship with Doctors, be sensitive and professional.
Educate staff and Doctors on new Developments from Managed Care Organizations.
Ensure the accuracy of all data relative to diagnosis, procedures and matching coding CPT4 and ICD10 and any other coding required by Managed Care Organizations.
Assist in the audit process to ensure that billings are accurate and timeous.
Daily Ward rounds to manage care of patients effectively, with the Medical Aids.


REQUIREMENTS:

Standard 10 (Grade 12).
Computer literate in all applications of MS Office.
Must have completed basic ICD10 and CPT Coding Courses.
Registered Nurse with a five-year experience, ideally ICU and NICU experience essential.
Must have worked in a Private Hospital for two years doing Case Management.
Extensive Clinical Skills.
Ability to increase Revenue and Turnover.

SKILLS:

Mature and Professional attitude, personality and character traits.
Sound reputation credibility with doctors.
Capable of administration duties.
Capable of working to large extend on their own.
Very good inter personal communication skills, to build sound relationship with doctors, patients, medical aid contact person/s and with other Hospital Departments.
Task orientated and the ability to work under tremendous pressure.
Business orientated – Highly motivated, “go-getter”.
A high level of accuracy and meticulousness is required.
Ability to increase Revenue and Turnover.

Remuneration: Negotiable on qualifications and experience.

Working Hours: 40 hours per week, i.e. Monday to Friday from 08H00 till 16H30 with a 30-minute meal interval.