Case Manager (Hospital Group)

at  Glasshouse Recruiting

REQUIREMENTS:

• Nursing or Case Management qualification/experience
• Clinical Nursing/ Managed Healthcare experience
• ICD-10 / CPT Coding qualification or experience
• SAP IS-H experience advantageous
• Proficiency in Microsoft Office products

CASE MANAGEMENT EXPERIENCE:

• Hospital
• Funder
• Non-Clinical or Assistant Case Manager

THE MAIN PURPOSE OF THIS POSITION:

The Case Manager utilising clinical knowledge, experience and patient acuity scoring tools, mitigates financial risk through comprehensive and accurate coding of hospital events
Communication with funders on justification for hospitalisation level of care and length of stay in hospital

DUTIES & RESPONSIBILITIES:

• 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 Health Care rules of engagement
• Compliance with all industry relevant legislative acts, regulations and circulars