Case Manager

Case Management

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

• Grade 12/Matric
• Diploma in Nursing or B Degree Nursing Qualification is essential 

• Three or more years of experience in Private Healthcare
• SAP experience will be advantageous
• Previous experience in case management
• Intermediate computer skill
• ICD & CPT Coding would be advantageous
• 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
• 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.