Clinical Case Manager

3 days ago


Pietermaritzburg, KwaZulu-Natal, South Africa Immploy Recruitment Agency CC Full time
Job Title: Clinical Case Manager

We are seeking a highly skilled Clinical Case Manager to join our team at Immploy Recruitment Agency CC. The successful candidate will be responsible for efficient patient case management and the delivery of an excellent service to internal and external customers.

Key Responsibilities:
  • Carry out clinical coding in accordance with CPT and ICD requirements.
  • Ensure that pre-admission and pre-authorisation information is accurate and in accordance with hospital and funder procedures.
  • Maintain patients' clinical status in accordance with funder approval requirements for the duration of hospitalization; keeping patients informed and managing the entire hospital stay's financial risk.
  • Provide complete and accurate updates and discharge information of all accounts.
  • Maintain accurate accounts of all admissions.
  • Handle patient files in accordance with hospital procedures. Timeous electronic submission of accounts and follow up on short payments arising from case management related issues.
  • Ensure the adherence of hospital staff to funder rules and coding procedures.
  • Keep well informed on legislation pertaining to funders and related Health Care matters.
Minimum Requirements:
  • SANC registration as a Registered Nurse or an Enrolled Nurse.
  • 5 years' experience as a case manager either at hospital level or with the Medical Schemes (preferably case management experience at hospital level).
  • Experience with Medical Aid administration procedures (ICD10, CPT 4 Procedure Codes and Per Diems).
  • Knowledge of hospital billing and tariffs and Hospital Information System will be advantageous.
  • Ability to build good relations with various internal and external stakeholders.

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