Case Manager

4 days ago

Johannesburg, South Africa Clinix Health Group (Pty) Ltd Full time

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

**Minimum Qualifications and Experience***
- Nursing degree / diploma.
- Current registration with South African Nursing Council.
- CM or Billings Clerk with ICD training and anatomy and physiology course certification.
- IDC and CPO coding.
- 3-5 years’ experience as a hospital case manager.

**Minimum Job Requirements**:

- 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 Funder.
- 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 Funder.
- Ensure to remain in the group and facility targets of 3 days for WIP (work in progress) and DNYB (discharged not yet billed).

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