Case Manager | Specialised Units Job Mount Edgecombe South Africa,Healthcare

Location: Mount Edgecombe

Function Patient services Facility Position Case Manager | Specialised Units Introduction

A vacancy exists for a Case Manager Specialised Units
, based at Life Mount Edgecombe Hospital
, reporting to Sahil Haripersad
, Finance and Administration Manager
. The successful candidate will be responsible for the management of the financial and clinical administrative risks pertaining to patients in specialised units – Intensive care units, high care units and neonatal intensive care units as well as support general units when required.

Critical Outputs

Ensuring operational excellence by

Conducting ward rounds and ensuring the accurate complete collection of clinic data from patient files and liaisons with nursing staff and attending clinicians

Updating accurate clinical information to justify length of stay and level of care to medical funds of specialised unit cases and where operationally required general ward cases.

Updating and providing the necessary information to funders regarding high value items, limited benefits and protocols as defined by managed care organizations

Communicating funder requirements / responses to attending clinicians and patients where necessary, and ensuring compliance with industry standards

Ensuring effective management of real time and manual messaging, including requests, responses, rejections and submissions.

Ensuring the accurate submission of accounts to funders.

Complying with governance and risk management requirements by ensuring adherence to patient services policies and procedures

Ensuring compliance to service level agreements with internal and external stakeholders

Ensuring effective management of revenue by

Ensuring the accurate and complete coding of patient accounts

Ensuring the correct application and correct interpretation of funder RSRT contracts and FFS claims

Reporting RSRT risks identified to the relevant manager

Ensuring effective management of quality outputs by

Adhering to patient services escalation processes and customer services standards

Investigating and reporting published alerts incidents and agreeing upon appropriate action with internal and external stakeholders

Ensuring effective management of relationships with internal/external stakeholders by

Building and maintaining relationships with internal stakeholders

Providing and facilitating training regarding RSRT contracts

Providing feedback and information regarding concerns or issues raised by external stakeholders

Providing feedback on external stakeholders impacting on the efficiency and effectiveness of the case management process

Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings

Requirements

Diploma or degree in Nursing, Physiotherapy, Clinical Associates, Paramedics as Critical Care Assistants or Emergency Care Practitioners or any other qualification that covers Anatomy, Physiology, Pathophysiology and Microbiology as foundational courses. Experience including proven leadership, change and people management

Current registration with the relevant professional / regulatory body (South African Nursing Council)

Understanding of clinical coding, clinical terminology and anatomy, funder rules, co-payments and exclusions

Past experience in ICD and CPT coding, competency to be shared with CV

Working knowledge of COID

Understanding of business and change management principles

Computer and iPad proficiency

Experience working in an environment with a Cardiac ICU, Cathlab, Cardiac theatre and Vascular lab is advantageous

Competencies

Problem-solving, analysis and judgement

Resilience

Engaging diversity

Verbal & written communication and presentation

Influencing

Drive & energy

Excellence orientation

Ethical behaviour

Building relationships

Customer responsiveness

Organisational awareness

Leading my example (Key for Managers)

Motivating and developing people (Key for Managers)


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