Hospital Case Manager

**Job Advert Summary**:
Are you in the market for a case manager opportunities at a well-known and dynamic agency? MHR is urgently looking for experienced **Specialised Case Managers** ( specialised units - Intensive care units, high care units and neonatal intensive care units) to work at a private hospital in **Heidelberg area** in **Johannesburg**.

**Minimum Requirements**:
**Requirements**:

- Professional Nurse with at least 5 years’ experience of which at least 2 should be in a specialised unit
- Experience including proven leadership, change and people management
- 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
- Computer proficiency

**Competencies**
- Attention to detail
- Problem-solving, analysis and judgement
- Resilience
- Engaging diversity
- Excellent verbal and written communication skills
- Professional and technical proficiency
- Building relationships
- Influencing skills
- Action orientated

**Duties and Responsibilities**:
**Ensuring the maximisation of revenue by**
- Ensuring accuracy of coding
- Participating in meetings and reporting losses to RSRT team and recommending corrective actions
- Monitoring insurance verification and workflow processes

**Ensuring effective management of quality outputs by**
- Performing quality walkabouts and implementing corrective measures
- Implementing and monitoring quality improvement programmes
- Adhering to patient services escalation processes in order to achieve QMS targets
- Monitoring Q-evaluator scores and implementing corrective measures
- Investigating internal and external stakeholder complaints
- Ensuring the adherence to customer service standards

**Ensuring operational excellence by**
- Monitoring submission of accurate accounts to funders
- Updating length of stay and level of care to funders of general ward cases and where operationally required specialised unit cases.
- Releasing care risk targets and submission within two days of discharge
- Ensuring compliance with company policies and managing authorisations and claim submissions, rejections and delays
- Ensuring governance and risk management by monitoring and adhering to patient services policies and procedures
- Ensuring compliance to service level agreements with internal and external stakeholders
- Ensuring all billing checks are closed by the relevant function areas

**Ensuring effective management of relationships with internal/external stakeholders by**
- Building and maintaining relationships with internal stakeholders
- Providing feedback and information on concerns or issues raised by internal stakeholders
- Providing and facilitating training regarding RSRT contracts to the relevant internal stakeholders
- Ensuring effective communication with external stakeholders
- Managing escalated concerns from Case Managers with external stakeholders
- Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings