Life Group Vacancies – Case Manager General Ward

Job Description:

A vacancy exists for a Case Manager General Ward based at Life Westville Hospital, reporting to Kenny Veeran, Patient Services Manager. The successful candidate will be responsible for managing the financial and clinical risks of the patient in a general ward by ensuring accurate coding, clinical updates and accounts submissions of patient hospitalisation to achieve strategic objectives.

Job Responsibilities:

• Updating length of stay and level of care to funders of general ward cases and where operationally required specialised unit cases.
• Ensuring effective communication with external stakeholders
• Ensuring all billing checks are closed by the relevant function areas
• Releasing care risk targets and submission within two days of discharge
• Ensuring governance and risk management by monitoring and adhering to patient services policies and procedures
• Ensuring accuracy of coding
• Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings
• Monitoring submission of accurate accounts to funders
• Ensuring the correct application and interpretation of RSRT’s
• Ensuring the compliance to LHC policies and managing authorisations and claim submissions, rejections and delays
• Managing escalated concerns from Case Managers with external stakeholders
• Ensuring compliance to service level agreements with internal and external stakeholders
• Monitoring insurance verification and workflow processes
• Providing and facilitating training regarding RSRT contracts to the relevant internal stakeholders
• Participating in meetings and reporting losses to RSRT team and recommend corrective actions

Job Requirements:

• Problem-solving, analysis and judgement
• Organisational awareness
• Building relationships Customer responsiveness
• Resilience
• Verbal & written communication skills
• Influencing skills
• Engaging diversity
• Attention to detail

Qualification & Experience:

• Nursing Qualification, preferably Professional Nurse with at least three years’ experience or Enrolled Nurse with proven case manager and clinical coding experience of at least 3 -5 years.
• Computer proficiency
• Current SANC registration
• Knowledge of Funder contracts, scheme rules, exclusions and benefits
• Understanding of private hospital industry and practices
• Knowledge and understanding of CPT & ICD coding
• Knowledge of hospital patient services and case management processes

Job Details:

Company: Life Healthcare

Vacancy Type:  Full Time

Job Location: Westville, KwaZulu-Natal, SA

Application Deadline: N/A

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