Case Manager

**Location: Clinix Botshelong-Empilweni Private Hospital (Vosloorus).**

**Reports to: Patient Services Manager.**

**Job Summary**:
To plan, coordinate and execute case management work at hospital level. The incumbent utilises clinical knowledge to minimise financial risk and ensure accurate billing through comprehensive accurate coding of patient care.

**Minimum Qualifications and Experience**:

- Relevant Nursing Qualification: Enrolled Nurse / Registered Nurse
- Current registration with the South African Nursing Counsel
- Case Management or Billings Clerk with ICD training and Anatomy and Physiology course certification
- Preferred qualification: Advance Certification in Intermediate coding
- Computer literacy
- ICD Code & CPT Coding ability and understanding of diagnostic related groupers.
- 5 years’ experience as a hospital case manager

**Minimum Job Requirements**:

- Proficiency in understanding the core specialties in the facility.
- Revenue cycle management working knowledge and conversant in regulations and practices governing the sub function.
- Liaise with Receptionist Ensure authorizations on admissions (daily) is accurate as per SAP system.
- Liaise with Receptionist for authorisations
- Ensure compliance to case management procedures, standards and protocols
- Plan, coordinate and execute Clinical coding in accordance with relevant CHG standards and protocols
- Ensure accurate, appropriate and complete diagnostic and procedural coding of all patient records in the hospital
- Timeously and consistently communicate and follow up with Funders (Medical Aids, COID, Government, RAF, DOL, etc.)
- Provide appropriate clinical information to Funders in order to update Length of Stay, Level of Care, formulary utilisation, assistive devices / Prosthesis, diagnostic interventions, therapy intervention and procedural interventions and required change in the facility.
- Consult daily with all relevant health care providers with regards to patient treatment
- Ensure the maintenance of patients’ clinical status (subsequent interventions and treatments) in accordance to Funder requirements for the duration of hospitalisation
- Ensure the correct categorisation and management of different patient accounts to facilitate reimbursement by Funders
- Ensure accurate and timeous finalisation of cases to facilitate reimbursement by Funders
- Minimise financial risk by the effective management of patient hospitalisation
- Follow the established and approved escalation processes in the event of a decline of payment by Funders
- Ensure to remain in the group and facility targets of 3 days for WIP (work in progress) and DNYB (discharged not yet billed).