Case Manager - Tembisa

Duties & Responsibilities

• 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)

Desired Experience & Qualification

• Relevant Nursing qualification

• CM or Billings Clerk with ICD training and anatomy and physiology course certification

• IDC and CPO coding

• Must have worked previously as a Registered Nurse

• 3-5 years’ experience as a hospital case manager