Hospital Case Manager

MHR is urgently looking for an experienced Hospital Case Manager (Registered Nurse) for a permanent position at a private rehabilitation hospital in Newlands in Cape Town in the Western Cape province to start asap

Benefits include:

• Provident fund contribution
• Risk Benefit contribution
• Medical Aid

• Must be available immediately
• Relevant nursing qualification (Diploma in General Nursing / B Cur Degree)
• Registered with the South African Nursing Council as a Professional Nurse
• 3 years in a hospital or medical scheme environment
• 1-2 years in case management will serve as an advantage
• Desired experience in Operations, Funder rules and principles and Case Coordination
• Risk Management
• Understanding of operational systems e.g. billing, Information Systems
• Marketing
• Intermediate knowledge of Microsoft Office suite
• Knowledge of the Scientific Nursing Process and associated procedures will be an advantage
• Knowledge of the rules and regulations regarding medical aid schemes will be an advantage
• Knowledge of clinical codes and coding policies
• Knowledge of patient administration systems, policies and procedures will be an advantage
• Experience in a Managed Healthcare environment will be a strong recommendation
• Independent problem-solving and decision-making skills
• Good accuracy and attention to detail skills in order to maintain high standards of work output
• Understands the interrelationships between business processes
• Maintains a customer-focused mindset that acknowledges the value of the customer

Job Purpose:To coordinate the care of the patient between all members of the multi-disciplinary team and funder from pre-admission to discharge Customer Satisfaction (Customer is identified as patient, family members, funders, referring institutions and professionals.)
• Make contact with patient and family prior to admission and at key intervals to inform them of funder requirements and related communication, length of stay authorisation and discharge planning.
• Ensure that the patient flow process is smooth, efficient and conducive to patient satisfaction.
• Liaise with funders and referring parties with regards to transfer of patients.
• Actively participate in family meetings to assist with authorisation and benefit management.
• Assist with authorisation and procurement of discharge equipment and oxygen.
• Coordinate feedback from multi-disciplinary team and provide referring doctor and funders with detailed management, progress and discharge reports.Patient Care:
• Conduct thorough clinical assessments of patients prior to admission to ensure that transfers and admissions are in line with criteria.
• Ensure that all parties involved in care of patient are briefed on diagnosis, medication usage and anomalies.
• Attend the multi-disciplinary team meetings to coordinate care and provide feedback to funders with regards to updates on clinical statusOperations
• Identify patients and manage total patient case from admission to discharge between funders and hospital.
• Coordinate and update all patient information, such as authorisations etc., between admin staff and funders.
• Build and maintain productive working relationships with all key stakeholders through on-going communication and feedback.
• Proactive communication regarding changes and initiatives to key stakeholders.
• Participate in recruitment of referring doctors and other members of the professional team.
• Identify, monitor, resolve, communicate and where necessary escalate deviations that may lead to discontentment and decreased occupancy levels.
• Be aware of budgetary targets with regards to occupancy levels and work as part of the team to achieve set targets.
• Identify high risk patients that may compromise infection control principles and alert unit manager of such risk.Brand awareness:
• Create awareness of the Intercare sub-acute hospital amongst key stakeholders example acute hospitals, funders and doctors.
• Showcase the facility on request to prospective patients, doctors and funders.