Case Manager- Soweto

Clinix Health Group Pty Ltd · Soweto, Gauteng

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JOB SUMMARY

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

REQUIREMENTS

Minimum Requirements

DELIVERABLES

To 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 Funders
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 Funders
Ensure to remain in the group and facility targets of 3 days for WIP work in progress and DNYB discharged not yet billed

Closing Date 29 September 2026