Case Manager

**Requirements**:

- Qualified Registered Nurse
- A qualified EN with relevant experience would be considered
- Both need to registered with SANC and proof of indemnity cover
- Minimum 3 years nursing experience in a multidisciplinary hospital.
- Experience and exposure in Theatre and/or ICU would be advantageous
- Hospital or Medical Aid scheme case management would be an advantage.
- Experience in ICD 10 and CPT coding is essential
- Knowledge of Prescribed Minimum Benefits (PMB) Scheme rules and policies
- Excellent communication skills (written and spoken)
- Excellent analytical and problem-solving skills
- Excellent MS Office computer skills, i.e. Outlook, Word, Excel, Kronos, Clinic Manager, etc.
- Attention to detail
- Ability to cope well under pressure

**Key Outputs**:

- Assess patient conditions and needs to develop appropriate care plans
- Interact with patients and medical aid schemes
- Resolve patient and medical aid scheme queries
- Update all information timeously and accurately
- CPT and ICD coding
- Obtain doctors letters, motivations, and justifications in all appropriate cases under managed care of where medical aids request them from their hospitals as part of their assessing process
- Monitor patient admissions and identify those who have limitations, restrictions, place by their managed care/ medical aid structures e.g. length of stay, cost restrictions, fixed fees, per diem and other limiting fees or drugs and/ or formularies
- Maintain a control system that ensures the systematic monitoring of managed care patients
- Handling patient queries
- Update hospital information

Ability to commute/relocate:

- Athlone, Western Cape: Reliably commute or planning to relocate before starting work (required)