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Case Management

Harrismith

17 Jul 2023

Administration

The Case Manager will be responsible for the liaison between the patient and medical aids to secure payment for the hospital.

  • Ensure all the relevant details on Hospital Billing System are updated and are accurate
  • Supply all details regarding patients history to Clinical partners
  • Monitor and control costs for Managed Care Organisation patients
  • Confirm length of stay for all Managed Care Organisations patients
  • Accompany Managed Care Organisation Case Managers on ward rounds in the hospital
  • Assist with final authorisation of Managed Care patient files
  • Ensure correct coding for all Managed Care Organisation patients
  • Consult with the relevant service providers regarding the patient care treatment
  • Assist with the transfer of patients to Rehab Hospital or step-down facilities
  • Liaise network of internal and external stakeholders to ensure that managed care of patients is maintained
  • Work effectively and co-operatively with others to establish and maintain good working relationships that are mutually beneficial.

  • Grade 12 or equivalent NQF level 4 qualification
  • Diploma in Nursing or B Degree Nursing Qualification
  • Registration with the South African Nursing Council

  • Three or more years of experience in a private Hospital as a Case Manager
  • SAP experience will be advantageous.
  • Previous experience in stock management 

  • SAP system Essential
  • Intermediate computer skill
  • Knowledge of Medical Aids
  • ICD-10 / CPT-4 Coding Qualification
  • NHN Billing Guidelines
  • Knowledge of funder contracts and exclusion would be advantageous.