CASE MANAGER X 1

Department.

Responsible for the case management process within the hospital.

Interacts with medical schemes to ensure that authorizations are provided timeously. ICD 10 and CPT clinical coding as per policies and procedures.

Ensures accurate application and interpretation of specialized wards criteria.

Provides support for the management of alternative fee structures. Liaison with doctors on funder requirements when necessary. Continuous performance and quality management.

Interpretation and implementation of scheme benefit rules.

Maintains client service principles to ensure client expectations are met. Optimizing of billing processes.

Auditing of patient files for accurate account submission.

Account release as per NHN billing guidelines, medical aid rules and contracted agreements.

Daily report utilization and management.

Communication:

Liaise with Doctors regarding patient’s progress.

Obtain Doctor’s motivation for appropriate managed care. Liaise with nurses in the wards and pharmacy staff.

Advise patients regarding limitations or restrictions on medical aid fees and length of stay.

Liaise with Case Managers of managed care organisations regarding pre- authorisations and additional care.

Requirements/Criteria

Registered with South African Nursing Council as an Enrolled Nurse or Professional

Nurse.

Must have ICD10 coding and CPT coding qualification.

Must have at least 2 years of relevant work experience in private healthcare environment.

Knowledge and experience with account billing and ARM agreements. Proven Computer Literacy skills(MS Office package)

Knowledge and Experience in administering medical and managed care processes. Good Interpersonal and communication skills

No late applications will be accepted or considered.