Case Manager

**20th June, 2023**:
**Responsibilities**:

- Ensure appropriate, complete and relevant diagnostic and procedural coding of all patient records within the hospital.
- Application of clinical knowledge for effective ICD 10 and CCSA coding of patient Events.
- Clinical coding of all patient events with valid ICD 10 and CCSA codes relevant to diagnosis, treatment rendered, and procedures carried out.
- Review clinical coding during patient stay in hospital.
- Application of clinical knowledge in the risk management of patients in terms of length of stay, level of care and medical aid benefits available.
- Monitor and action risk related to medical aid benefits and hospitalization.
- Provide clinical data to substantiate length of stay and level of care.
- Accompany Managed Care Organisation Case Managers on ward rounds in the hospital, if required.
- Ensure correct clinical coding for all patients.
- Releasing of patient accounts for billing; relating to coding, LOS/LOC to ensure submission of an accurate hospital invoice. Consult with the relevant service providers regarding the patient treatment.
- Daily clinical rounds to all patients to allow for assessment and evaluation of patients to motivate for LOS, LOC and treatment.
- Electronic clinical updates to managed care organization/insurance providers, to motivate for patients’ level of care and length of stay in hospital.
- Final authorisation/releasing of all discharged patient accounts for final billing after reviewing authorisation of length of stay, level of care, and Coding. Monitoring and managing costs effectively for all patients/Risk management
- Monitoring the patients in progress report and ensuring that patients ward movements, bed status and level of care on the system is accurate.
- Facilitate discharge planning and movement of patients to step-down or rehab facility.
- Assist with case management queries and investigations from funders, doctors and patients.
- Participate in the transition of care project as per policy.
- Capturing of Risk factors
- Maintaining patient confidentiality
- Ability to implement changes effectively.
- Manage associated administrative tasks.
- Assist with any other duties assigned by the Billings Manager from time to time.
- Compliance with all industry relevant legislative acts, regulations and circulars
- Liaise with a network of internal and external stakeholders.
- 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.
- Effective communication to medical schemes by utilising the rules of engagement published in the Tariff and Billing Guidelines.
- Effective communication, collaboration and consultation with other role players in the healthcare team.
- Provide appropriate clinical information to MCO
- Effective and timeous communication with the members of the fund when appropriate.
- Identify own training needs and communicate with line manager.
- Identify own training needs and communicate with line manager.
- 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.

**Requirements**:

- B Degree / Diploma Nursing qualification or equivalent NQF level 6 or Enrolled Nursing qualification or equivalent NQF level 4.
- Qualification in associated Healthcare sciences or Managed care/ Case management
- 3 years professional healthcare experience.
- Intensive Care Nursing experience is beneficial
- Previous hospital and medical scheme case management experience is beneficial
- General administrative skills
- Computer literate
- ICD 10 and CCSA coding experience/qualification

**Salary is market related