Case Manager Specialised
- Life Flora Hospital
- Case Manager Specialised
A vacancy exists for a Specialised Case Manager based at Life Flora Hospital reporting to the Patient Services Manager, Esvory De Jager. The successful candidate will be responsible for the financial and clinical administrative risks pertaining to patients and units. This person will be responsible to effectively communicate and deliver an uncompromising quality of service to all internal and external customers by ensuring that all clinical updates and coding are of the highest standard for all specialised cases. Life Healthcare has a mandatory COVID-19 vaccination policy in place which requires all employees to be COVID-19 vaccinated.
- Critical Outputs
- Conduct ICU rounds and ensure the accurate complete collection of clinical data from patient files and liaisons with nursing staff and attending clinicians
- Update accurate clinical information to justify length of stay (LOS) and level of care (LOC) to medical aid funds or their assigned managed care organisations.
- Update and provide the necessary information to funders regarding high value (HV) items, limited benefits and protocols as defined by managed care organisations.
- Communicate funder requirements and 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
- Ensure the accurate submission of accounts to funders
- Ensure the correct application and correct interpretation of funder RSRT contracts.
- Ensure the correct application and correct interpretation of funder FFS claims
- Ensure compliance to all Policies & Work Procedures to minimise Clinical and Financial Risk
- Action and close off short payment queries associated with assigned responsibilities.
- Report RSRT risks identified to manager
- Adherence to patient services escalation processes
- Drive adherence to customer service standards
- Drive adherence to AMI compliance
- Foster and maintain healthy relationships with all internal and external stakeholders
- Qualified Registered Nurse with SANC registration
- Clinical Coding experience of at least one year and / qualification in clinical coding (ICD 10 and CPT coding)
- Case management experience
- Knowledge of clinical terminology and anatomy, funder rules, co-payments and exclusions
- Working knowledge of COID
- Understanding of business and change management principles
- Computer proficiency
- ICU Experience will be an added advantage
- Problem-solving, analysis and judgment
- Attention to detail
- Engaging diversity
- Professional and technical proficiency
- Excellence orientation
- Building relationships
- Customer responsiveness
- Organisational awareness
- Action orientation
- Ethical behaviour
- Closing date
- Tuesday, May 10, 2022
Internal applicants - Before making an application, you are requested to discuss your application with your line manager. 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.
Please note that Life Healthcare has a mandatory Covid vaccination policy.
Only vaccinated external candidates will also be considered.
Thank you for your interest in this opportunity. Kindly note that only shortlisted candidates will be contacted. Applicants who have not been contacted within two weeks of the closing date of this advert, should consider their application as unsuccessful.