Case Manager X 2

To plan, coordinate and execute case management work at hospital level. The incumbent utilises clinical knowledge to minimise financial risk and ensure accurate billing through comprehensive accurate coding of patient care.

• Nursing Diploma
• Registered Nurse
• ICD Code & CPT Coding knowledge
• 3-5 years' experience as a hospital case manager

• Liaise with Receptionist for authorizations.
• Ensure compliance to case management procedures, standards and protocols.
• Plan, coordinate and execute Clinical coding in accordance with relevant CHG standards and protocols.
• Ensure accurate, appropriate and complete diagnostic and procedural coding of all patient records in the hospital.
• Timeously and consistently communicate and follow up with Funders (Medical Aids, COID, Government, RAF, DOL, etc.)
• Provide appropriate clinical information to Funders in order to update Length of Stay, Level of Care, formulary utilization, assistive devices / Prosthesis, diagnostic interventions, therapy intervention and procedural interventions and required change in the facility.
• Consult daily with all relevant health care providers with regards to patient treatment
• Ensure the maintenance of patients' clinical status (subsequent interventions and treatments) in accordance to Funder requirements for the duration of hospitalization
• Ensure the correct categorization and management of different patient accounts to facilitate reimbursement by Funders.
• Ensure accurate and timeous finalization of cases to facilitate reimbursement by Funders.
• Minimize financial risk by the effective management of patient hospitalization.
• Follow the established and approved escalation processes in the event of a decline of payment by Funders.

Ensure to remain in the group and facility targets of 3 days for WIP (work in progress) and DNYB (discharged not yet billed).