Case Manager

Management Company - Durban

31 May 2022


The Case Manager will be responsible for the liaison between the patient and medical aids in order to secure payment for the hospital. NOTE this is a Travel Requirements Position. The incumbent will be required to travel and work at the various regions of Busamed Hospitals where there is critical demand for assistance with case management.

  • Grade 12 or equivalent NQF level 4 qualification
  • Diploma in Nursing Qualification is essential
  • ICD & CPT Coding certificate essential

  • Previous Case Management experience advantages
  • Intermediate computer skill (Excel and Word)
  • Excellent Interpersonal and communication skills & Knowledge of Medical Aids

  • 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
  • Arrange in-service training for relevant staff to meet the needs of the theatre department
  • 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
  • Manage the Group Debtors Age Analysis rejections from funders with the Hospital Case Management Teams