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Clinical Case Manager Specialist
1 week ago
Job Description:
Hire Resolve seeks a skilled Hospital Case Manager to join their team in Eastern Cape. The successful candidate will be responsible for coordinating patient care, ensuring accurate medical coding, and optimizing hospital reimbursements while maintaining high-quality patient care standards.
Key Responsibilities
- Patient Case Management: Assess and manage patient cases to ensure efficient hospital care and appropriate medical aid approvals.
- Authorization & Pre-Approvals: Obtain authorization for hospital admissions and liaise with medical aids to ensure timely approvals.
- Clinical Coding: Ensure accurate ICD-10 and CPT coding for billing purposes.
- Utilization Review: Monitor length of stay, treatment plans, and resource utilization to optimize hospital efficiency.
- Collaboration: Work closely with doctors, nurses, and medical aid schemes to facilitate smooth patient care processes.
- Compliance & Reporting: Maintain documentation and ensure compliance with medical aid policies, hospital protocols, and legal standards.
- Patient Advocacy: Support patients by explaining medical aid benefits and assisting with any coverage issues.
Requirements
- Qualification: Diploma/Degree in Nursing or a related healthcare field.
- Clinical Coding Certification (advantageous).
- Experience: At least 23 years of experience in hospital case management or a similar role.
- Knowledge of ICD-10 & CPT Coding.
- Strong understanding of medical aid processes and hospital billing systems.
- Excellent communication and negotiation skills.
- Ability to work in a fast-paced hospital environment.
