Job Description

If you are an energetic and committed Case Manager, consider joining our client, a private hospital based in Bellville.The Purpose of the role is designed to support the improvement and management of cost-effective healthcare services. It involves optimizing healthcare delivery, ensuring that resources are used wisely. Minimizing unnecessary expenses while maintaining high standards of patient care and implementing strategies to contain and reduce the associated costs of these servicesSkills

• Excellent communication skills (written and spoken)
• Excellent analytical and problem-solving skills
• Excellent MS Office computer skills, i.e. Outlook, Word, Excel, Kronos, Clinic Manager, etc.
• Attention to detail
• Ability to cope well under pressure

KEY OUTPUTS:

• Knowledge of CPT and ICD coding
• Update hospital information
• Pre-screening of all patients while in hospital, prior to admission to the facility to ensure suitability for the facility
• Assess patient conditions and needs to develop appropriate care plan
• Interact with patients and medical aid schemes
• Explain the authorisation and admissions process to the patient
• Resolve patient and medical aid scheme queries
• Upon completion of assessment, inform the relevant individuals in order to continue with the admission process.
• Liaise with Healthcare Manager on a daily basis on bed availability and services, Support discharge planning efforts.
• Obtain doctors letters, motivations, and justifications in all appropriate cases under managed care of where medical aids request them from their hospitals as part of their assessing process.
• Monitor patient admissions and identify those who have limitations, restrictions, place by their managed care/ medical aid structures e.g. length of stay, cost restrictions, fixed fees, per diem and other limiting fees or drugs and/ or formularies.
• Updating all information timeously and accurately to Maintain a control system that ensures the systematic monitoring of managed care patients.
• Ensure any special requests from the patient is noted on the internal system i.e.: transfers, special diets, isolation precautions etc.

REQUIREMENTS:

• Qualified Registered Nurse
• Registration with SANC and proof of indemnity cover
• Minimum 2 years experience
• Previous experience in a private hospital would be advantageous
• Knowledge of ICD 10 and CPT coding
• Knowledge of Prescribed Minimum Benefits (PMB) Scheme rules and policies
• Medical-aid background in Case Management Department

Apply by submitting your updated CV for consideration. If you haven't received a response from us within two weeks, please assume that your application has not been successful.For more information please contact:Tersia Frantz

SD Recruitment