PermanentJob for Experienced Hospital Case Manager Required
Job for Experienced Hospital Case Manager Required
Location: Western Cape
Job Type: Permanent
Job Title: Job for Experienced Hospital Case Manager Required
Includes the following – Other Duties may be assigned. Responsible for the case management process within the sub-acute hospital.
Conduct ward rounds and ensure the accurate complete collection of clinic 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 funds the assigned managed care organization.
Update and provide the necessary information to funders regarding HV (high value) items, limited benefits and protocols as defined by managed care organizations.
Communicate funder requirements / responses to attending clinicians and patients where necessary, and ensure compliance with industry standards.
Ensure effective management of real time and manual messaging, including request, responses, rejections and submissions.
Ensure the accurate submission of accounts to funders.
Understand and ensure adherence to patient’s services policies and procedures.
Ensure accurate and complete coding of patient accounts.
Ensure the correct application and correct interpretation of funder contracts.
Ensure the correct application and correct interpretation of funder FFS claims
Action and close off short payment queries associated with assigned responsibilities.
Report RSRT risk identified to manager.
Adherence to patient services escalation processes.
Drive adherence to customer service standards.
Foster and maintain healthy relationships with internal stakeholders. E. g. nursing, pharmacy and business hubs.
Interacts with referring doctors and referring hospital staff to ensure that patients that need the service provided by the Company are referred.
Interacts with medical schemes to ensure that authorisations are provided timeously.
Verification of clinical coding as per policies and procedures.
Ensures accurate application and interpretation of specialised wards criteria.
Provides support for the management of alternative fee structures.
Liaison with doctors on further requirements when necessary.
Continuous performance and quality management.
Interprets and implements scheme benefit rules.
Maintains client service principles to ensure client expectations are met.
Auditing and final bill of all accounts.
Pharmacy medication capturing. (Billing)
Patient Release, discharge report to be send to relevant doctors.
Patient Referral forms to send to Medical Aids.
Liaise with Manager – Nursing Services regarding prioritization of work plan.
Network with other hospitals and case managers.
- Nursing background with relevant tertiary qualification.
- Registered with SANC – required.
- Knowledge of medical ICD-10 codes would be advantages.
- Valid Drivers license.
- Minimum Two years Hospital case management experience in a medium to large concern.
- Clinic Manager experience would be advantageous.
- Proficient in Microsoft office (Word, Excel, Outlook)
- Fully bilingual.
- Good English written and verbal communication.
- Excellent telephone manner with an overall pleasant disposition.
- Ability to be assertive when needed.
- Flexible work style.
- Collaborative – able to work well with people within and outside the company
- If you have not been contacted within 2 weeks consider your application unsuccessful
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