Job Description

Mediclinic Heart Hospital | Arcadia, Pretoria | South AfricaClosing date: 16/02/2025
Number of positions: 1
Recruiter name: Dumile Khethiwe Magagula
Reference number: 57686
Workplace Type: On-site
PermanentPlease note if you are an internal employee on a fixed term contract please apply using an external candidate profile and not your employee profileMAIN PURPOSE OF JOBTo coordinate the hospital case management process and facilitate the communication process between all role players by providing accurate and timeous clinical information to minimise the financial risk for the organisation.KEY RESPONSIBILITY AREASMinimise financial risk by effectively managing patient stayEnsure compliance to case management procedures, contracts and legal aspects by utilising available resources and systemsEnsure correct and timeous finalisation of cases to facilitate reimbursements from funders of claimsConsistently and timeously communicate with Funders as contractually agreed through the relevant case management channelsEnsure clinical coding standards are adhered to as per Level 3 coding guidelineLead and manage the people in the Case Management team (if applicable)REQUIRED EDUCATIONESSENTIAL EDUCATION: Clinical qualificationDESIRED EDUCATION: Registered Nurse / Professional Nurse or qualified ParamedicREQUIRED EXPERIENCEESSENTIAL MINIMUM EXPERIENCE: Minimum of 3 years in a clinical role; Experience in private healthcare environment or experience as an ILS/ALS ParamedicDESIRED EXPERIENCE: Experience in Theatre and or ICU; Medical aid background.REQUIRED JOB SKILLS AND KNOWLEDGE

• Anatomy; physiology and terminology
• Funder Contracts; Medical aid requirements/narrations
• Scientific nursing principles and process
• B2B EMS (electronic message system: check status of authorisations and use for trouble,shooting)
• Computer literate (Microsoft Office)
• Authorisation and motivation of Level of Care; Length of Stay; Short Payments etc.
• Relevant aspects of applicable statutory acts (e.g. Consumer Protection Act; PMB; etc.)
• Patient Administration policies and procedures (e.g. Patient Confidentiality; Visitation of external case managers; etc.)
• Daily workflow; managing deviances; coding; and case management processes
• Application of clinical codes and finalisation thereof (Level 3 coding)
• Patient admin programmes on the AS400 system

All applicants will be considered, with the understanding that preference will be given in accordance with the Employment Equity Plan of Mediclinic Southern Africa, as well as internal applicants/employees that meet the minimum requirements.Please note if you are an internal employee on a fixed term contract please apply using an external candidate profile and not your employee profileJoin our Talent CommunityBecome a part of our Talent Community and we will get in touch with you as soon as there is a relevant opening that fits your skills, interests and experience.Job Type: AdministrationVideo Token: KDIu6uSOve4Custom Field 1: v1658243237/MCSA_job_advert_header_mbsg7o.jpg

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