Case Manager - Hospital Group (Kimberley, Northern Cape)
Glasshouse Recruiting
Date: 4 days ago
City: Kimberley, Northern Cape
Contract type: Full time
Conducting ward rounds on identified patients to obtain clinical information from the patient files
Liaising with Nursing staff, Doctors and Fund Case Managers
Responsible for substantiating patient hospitalisation in terms of treatment, length of stay and level of care
Monitor and action risk related to medical aid benefits and hospitalisation
Ensure accurate, specific and comprehensive clinical coding
Timeous, effective communication and follow-up with medical aids
Review authorisation aspects approved and escalate when necessary
Audit LOS/LOC and release the case for billing
Effective communication to medical schemes and adhering to the standards contained in the NHN managed healthcare rules of engagement
Compliance with all industry relevant legislative acts, regulations and circulars
Nursing or Case Management qualification / experience
Case Management experience – Hospital / Funder
Clinical Nursing / managed healthcare experience
ICD-10 / CPT coding qualification or experience
SAP IS-H experience advantageous
Proficiency in Microsoft Office
Between 1 - 3 Years
Liaising with Nursing staff, Doctors and Fund Case Managers
Responsible for substantiating patient hospitalisation in terms of treatment, length of stay and level of care
Monitor and action risk related to medical aid benefits and hospitalisation
Ensure accurate, specific and comprehensive clinical coding
Timeous, effective communication and follow-up with medical aids
Review authorisation aspects approved and escalate when necessary
Audit LOS/LOC and release the case for billing
Effective communication to medical schemes and adhering to the standards contained in the NHN managed healthcare rules of engagement
Compliance with all industry relevant legislative acts, regulations and circulars
Nursing or Case Management qualification / experience
Case Management experience – Hospital / Funder
Clinical Nursing / managed healthcare experience
ICD-10 / CPT coding qualification or experience
SAP IS-H experience advantageous
Proficiency in Microsoft Office
Between 1 - 3 Years
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