Case Manager - Speciaised Units

Patient services
Life Peglerae Hospital
Case Manager - Speciaised Units

A vacancy exists for a Case Manager Specialised Units, based at Life Peglerae Hospital, reporting to Suzette can Rensburg , Patient Services Manager. The successful candidate will be responsible for the management of the financial and clinical administrative risks pertaining to patients in specialised units – Intensive care units, high care units and neonatal intensive care units.

Critical Outputs

Ensuring operational excellence by 

  • Conducting ward rounds and ensuring the accurate complete collection of clinic data from patient files and liaisons with nursing staff and attending clinicians
  • Updating accurate clinical information to justify length of stay and level of care to medical funds
  • Updating and providing the necessary information to funders regarding high value items, limited benefits and protocols as defined by managed care organizations
  • Communicating funder requirements / responses to attending clinicians and patients where necessary, and ensuring compliance with industry standards
  • Ensuring effective management of real time and manual messaging, including requests, responses, rejections and submissions.
  • Ensuring the accurate submission of accounts to funders.
  • Complying with governance and risk management requirements by ensuring adherence to patient services policies and procedures
  • Ensuring compliance to service level agreements with internal and external stakeholders

Ensuring effective management of revenue by

  • Ensuring the accurate and complete coding of patient accounts
  • Ensuring the correct application and correct interpretation of funder RSRT contracts and FFS claims
  • Reporting RSRT risks identified to the relevant manager

Ensuring effective management of quality outputs by

  • Adhering to patient services escalation processes and customer services standards
  • Investigating and reporting published alerts incidents and agreeing upon appropriate action with internal and external stakeholders

Ensuring effective management of relationships with internal/external stakeholders by

  • Building and maintaining relationships with internal stakeholders
  • Providing and facilitating training regarding RSRT contracts
  • Providing feedback and information regarding concerns or issues raised by external stakeholders
  • Providing feedback on external stakeholders impacting on the efficiency and effectiveness of the case management process
  • Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings
  • Nursing qualification, Registered Nurse with at least five years’ experience on which at least 2 should be in a specialised unit
  • Experience including proven leadership, change and people management
  • Current registration with the relevant professional / regulatory body
  • Understanding of clinical coding, clinical terminology and anatomy, funder rules, co-payments and exclusions
  • Working knowledge of COID
  • Understanding of business and change management principles
  • Computer proficiency
  • Problem solving, analysis and good judgment
  • Resilience
  • Engaging diversity
  • Verbal and written communication and presentation
  • Influencing
  • Drive and energy
  • Excellence orientation
  • Ethical behaviour
  • Building relationships
  • Customer responsiveness
  • Organisational awareness
  • Leading my example (Key for Managers) 
  • Motivating and developing people (Key for Managers)

Ayanda Sokhela

014 597 7278
Closing date
Friday, April 19, 2019

Internal applicants - Before making an application, you are requested to discuss your application with your line manager. Only short listed candidates will be contacted. Should you not receive any communication after 2 weeks of closing date, kindly consider your application as unsuccessful.

External candidates will also be considered.

Explore our vacancies and find the right opportunity for you. Download the application form and email to the relevant contact person specified in the job advertisement.

Life Healthcare is an equal opportunity employer.

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