The incumbent will be responsible for liaising between the patients, treating clinicians, and medical aids in order to provide an accurate and true account of the patient’s stay in hospital. The Case Manager will also assume responsibility for the application of clinical knowledge in the risk management of patients in terms of length of stay, level of care and medical aid benefits available.
- Application of clinical knowledge in the risk management of patients in terms of length of stay, level of care and medical aid benefits available.
- Update all relevant details on Adclin Info.
- Accompany Managed Care Organisation Case Managers on ward rounds.
- Provide appropriate clinical information to Medical aids.
- Facilitate with transfer of patients to Rehab or step-down facilities.
- Code all patients with ICD10 and CPT4 codes.
- Consult with all service suppliers regarding treatment and phone for patients.
- Assist with final authorisation of patient files.
- Daily liaison and communication with Medical Schemes, Hospital Nursing staff and medical practitioners
- Supply all details regarding patient’s history, etc. to clinical partners.
- Control costs for patients.
- Assist with case management of all medical aid patients.
- Intensive Care Nursing experience an advantage
- Hospital or Medical Scheme Case Management an advantage
- Knowledge of Managed Healthcare policies and procedures
- Computer Literate
- General administrative skills
- Minimum 3 years nursing experience in a multidisciplinary hospital environment
Qualification & Experience:
- Grade 12 /Matric
- Registered Nurse and registered with the SANC
- Diploma or Degree in Nursing
- Experience in ICD 10 and CPT 4 coding
Vacancy Type: Full Time
Job Location: Alberton, Gauteng, SA
Application Deadline: N/A