Case Manager

Case Management

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

• Grade 12 or equivalent NQF level 4 qualification
• Diploma in Nursing Qualification is essential / SANC registration is compulsory
• ICD 10 and CPT coding 

• Previous Case Management experience essential
• Intermediate computer skills
• Excellent interpersonal and communication skills
• Knowledge of Medical Aids
• ICD & CPT Coding essential

• Ensure all the relevant details on Hospital Billing System are updated and are accurate
• Management of the DNFB daily efficiently (sound knowledge of impact of failure to do so)
• Management of medical aid/ credit control queries timeously and accurately
• Time management to ensure all work-related tasks are completed daily
• Supply all details regarding patients’ history to Clinical partners/ Funders accurately, concisely and timeously
• 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
• Actively participate as a member of a team to achieve goals
• Active involvement in own professional development to maintain a satisfactory level of skill and knowledge
• Work effectively and co-operatively with others to establish and maintain good working relationships that are mutually beneficial.
• Develop collaborative relationships to help accomplish work goals and targets
• Liaise with Clinicians, Allied workers and patients with regards to concerns around authorisation, LOS and LOC