Hospital Case Manager

Mediclinic Panorama - Panorama, Cape Town, South Africa

To coordinate the hospital case management process and facilitate the communication process between all role players by providing accurate and timely clinical information to minimise the financial risk for the organisation.

• Minimise financial risk by effectively managing patient stay.
• Ensure compliance with case management procedures, contracts and legal aspects by utilising available resources and systems.
• Ensure correct and timely finalisation of cases to facilitate reimbursements from funders or claimants.
• Consistently and timely communicate with funders as contractually agreed through the relevant case management channels.
• Ensure clinical coding standards are adhered to as per Level 3 coding guideline.
• Lead and manage the people on the Case Management team (if applicable).

Desired Education Registered Nurse / Professional Nurse or qualified Paramedic.

Essential minimum experience Minimum of 3 years in a clinical role.

Desired experience Experience in Theatre and/or ICU, medical aid background, private healthcare environment or experience as an ILS/ALS Paramedic.

• Understanding of anatomy, physiology and medical terminology.
• Funder contracts; medical aid requirements and narratives.
• Scientific nursing principles and processes.
• Authorization and management of level of care, length of stay, clinical coding, high cost stock, short payments, etc.
• Use of electronic systems (e.g., B2B or funder portals) for requesting authorizations, performing case management updates and troubleshooting.
• Relevant aspects of applicable statutory acts (e.g., Consumer Protection Act, PMB).
• Patient administration policies and procedures (e.g., patient confidentiality; visitation of external case managers).
• Daily workflow, managing deviations, clinical coding, and case management processes.
• Application of clinical codes and finalization thereof.

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 who meet the minimum requirements.