Risk Management Specialist
1 week ago
Job Title: Case Manager
About the Role:
Oasis Health services is seeking an experienced Case Manager to join our team. As a Case Manager, you will be responsible for managing financial and clinical risks of patients in a general ward.
Key Responsibilities:
- Ensure accurate coding, clinical updates, and accounts submissions to achieve strategic objectives.
- Participate in meetings and report losses to the RSRT team and recommend corrective actions.
- Monitor insurance verification and workflow processes.
- Implement and monitor quality improvement programmes.
- Adhere to patient services escalation processes to achieve QMS targets.
- Monitor Q-evaluator scores and implement corrective measures.
- Investigate internal and external stakeholder complaints.
- Ensure compliance to LHC policies and manage authorisations and claim submissions.
- Ensure governance and risk management by monitoring and adhering to patient services policies and procedures.
Requirements:
- Nursing Qualification, Professional Nurse with at least three to five years' experience.
- Current SANC registration.
- Knowledge of hospital patient services and case management processes.
- Knowledge and understanding of CPT & ICD coding.
- Knowledge of Funder contracts, scheme rules, exclusions and benefits.
- Understanding of private hospital industry and practices.
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