Case Manager - RN/PN

SUMMARY:
A vacacy of a Case Manager (General) exists at a Private Hospital, reporting to the Finance Manager. The successful candidate will be responsible efficient patient case management and the delivery of an efficient and professional service to the internal and external customers.

POSITION INFO:
Key Responsibilities

• Carry out clinical coding in accordance with CPT and ICD requirements. 
• Ensure that pre-admission and pre-authorisation information is accurate and in accordance with hospital and funder procedures.
• Maintain patients’ clinical status in accordance with funder approval requirements for the duration of hospitalization; keeping patients informed and managing the entire hospital stays’ financial risk.
• Provide complete and accurate updates and discharge information of all accounts.
• Maintaining accurate accounts of all admissions.
• Handle patient files in accordance with hospital procedures. Timeous electronic submission of accounts and follow up on short payments arising from case management related issues. 
• Ensure the adherence of hospital staff to funder rules and coding procedures.
• Keep well informed on legislation pertaining to funders and related Health Care matters.

• SANC registration as a Registered Nurse or an Enrolled Nurse.
• 5 years’ experience as a case manager either at hospital level or with the Medical Schemes (preferably case management experience at hospital level)
• Experience with Medical Aid administration procedures (ICD10, CPT 4 Procedure Codes and Per Diems). 
• Knowledge of hospital billing and tariffs and Hospital Information System will be advantageous.
• Ability to build good relations with various internal and external stakeholders.