Healthcare Life Sciences Jobs – Case Manager

Job Description:

A vacancy exists for a Case Manager General Ward based at Life The Crompton Hospital, reporting to Jensen Soobramoney, Finance and Admin Manager. The successful candidate will be responsible for managing the financial and clinical risks of the patient in a general ward by ensuring accurate coding, clinical updates and accounts submissions of patient hospitalisation to achieve strategic objectives.

Job Responsibilities:

• Ensuring accuracy of coding
• Releasing care risk targets and submission within two days of discharge
• Ensuring the correct application and interpretation of RSRT’s
• Participating in meetings and reporting losses to RSRT team and recommend corrective actions
• Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings
• Ensuring effective communication with external stakeholders
• Ensuring governance and risk management by monitoring and adhering to patient services policies and procedures
• Managing escalated concerns from Case Managers with external stakeholders
• Ensuring the adherence to customer service standards
• Monitoring Q-evaluator scores and implementing corrective measures
• Updating length of stay and level of care to funders of general ward cases and where operationally required specialised unit cases.
• Investigating internal and external stakeholder complaints
• Monitoring submission of accurate accounts to funders
• Ensuring the compliance to LHC policies and managing authorisations and claim submissions, rejections and delays

Job Requirements:

• Organisational awareness
• Excellence orientation
• Attention to detail
• Influencing skills
• Ethical behaviour
• Problem-solving, analysis and judgement
• Customer responsiveness
• Building relationships
• Action orientation
• Resilience
• Professional and technical proficiency
• Verbal & written communication skills
• Engaging diversity

Qualification & Experience:

• Nursing Qualification, preferably Professional Nurse with at least three years’ experience or Enrolled Nurse with proven case manager and clinical coding experience of at least 3 -5 years.
• Current SANC registration
• Understanding of private hospital industry and practices
• Knowledge of hospital patient services and case management processes
• Computer proficiency
• Knowledge of Funder contracts, scheme rules, exclusions and benefits
• Knowledge and understanding of CPT & ICD coding

Job Details:

Company: Life Healthcare

Vacancy Type:  Full Time

Job Location: Pinetown, KwaZulu-Natal, SA

Application Deadline: N/A

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