The Case Manager utilising clinical knowledge and expertise, mitigates financial risk through comprehensive accurate coding of hospital events; as well as the justification of hospitalisation encompassing level of care and length of stay
- Compliance with all industry relevant legislative acts, regulations and circulars
- Work effectively and co-operatively with others to establish and maintain good working relationships that are mutually beneficial.
- Liaise with a network of internal and external stakeholders.
- Accompany managed Care Organisation Case Managers on ward rounds in the hospital, if required.
- Effective communication to medical schemes by utilising the rules of engagement published in the Netcare Tariff and Billing Guidelines.
- Monitor and action risk related to medical aid benefits and hospitalisation.
- Application of clinical knowledge in the risk management of patients in terms of length of stay, level of care and medical aid benefits available.
- Provide clinical data to substantiate length of stay and level of care.
- Ensure correct clinical coding for all patients.
- Ensure appropriate, complete and relevant diagnostic and procedural coding of all patient records within the hospital.
- Develop case management skills and expertise.
- Nursing and pharmacy policies and procedures.
- 3 years professional healthcare experience.
- Ability to develop and maintain clinical knowledge.
Qualification & Experience:
- Qualification in associated Healthcare sciences or Managed care/ Case management.
- B Degree/Diploma Nursing qualification or equivalent NQF level 6.
- Registered nursing qualification with registration at South African Nursing Council
Vacancy Type: Full Time
Job Location: Boksburg, Gauteng, SA
Application Deadline: N/A