Shelly Beach Hospital (Pty) Ltd has a vacancy for a Case Manager.
Role Summary The incumbent will be responsible for liaising between the patients, treating clinicians, and medical aids in order to provide an accurate and true account of the patient's stay in hospital.
Key Work Output and Accountabilities: Ensure all the relevant details on Hospital Billing System are updated and accurate.Assist clinicians and all allied facilities with account queries.Comply with governance and risk management requirements by adhering to patient services policies and procedures.Ensure effective management of real-time clinical updates, including requests, responses, rejections, and submissions.Ensure effective communication regarding funder requirements/responses to attending clinicians and patients where necessary, in compliance with industry standards.Meet targets of monthly cash collections/maintaining DNYB days on 5 days and below.Supply all details regarding patient's history to clinical partners.Monitor and control costs for Managed Care Organization patients.Confirm length of stay for all funders.Assist with final authorization of Managed Care patient files.Ensure correct coding for all Managed Care Organization patients.Consult with the relevant service providers regarding the patient care treatment.Assist with the transfer of patients to rehab hospital or step-down facilities.Liaise with a network of internal and external stakeholders to ensure that managed care of patients is maintained.Actively involve in own professional development to maintain a satisfactory level of skill and knowledge.Keep up to date with Shelly Beach Hospital's evolving policies and procedures.Competencies, Skills, Knowledge and Attributes: Organisational awareness and building good working relationships with service providers.Problem-solving and analysis skills.Sound knowledge of private hospital business operations.Experience in specialized units.Sound knowledge of the case management processes, ICD 10, and CPT coding.Sound knowledge of the general billings and tariff guidelines.The capacity to clearly present information, either written or verbal.Good verbal and interpersonal communication skills.Ability to work well under pressure and maintain effectiveness during changing conditions.Ability to prioritize by managing time and resources to ensure that work is completed effectively.Ability to produce work of a high-quality standard by accurately checking processes and tasks.Ability to maintain stable performance under pressure by handling stress in an acceptable way to personnel and the organization.Always maintain professional conduct and standards in accordance with hospital policies.Be highly motivated, positive, enthusiastic, and able to work under extreme pressure.Understanding of clinical coding and funder rules.Advanced coding experience.Inherent Requirements: A relevant nursing qualification that allows registration with the South African Nursing Council as a Registered Nurse or Enrolled Nurse.Proof of registration with SANC.At least 2-3 years of Case Management experience.Computer proficiency.Recommendations: Previous knowledge/experience of medical aids would be an advantage.Shelly Beach Hospital is an equal opportunity, affirmative action employer, whose aim is to promote equity in all occupational categories in the institution. Shelly Beach Hospital reserves the right not to fill the post.
Correspondence will be limited to shortlisted candidates only.
Shortlisted candidates should avail themselves for the interviews at the specified time and venue as determined by the hospital; otherwise, they will forfeit the opportunity. If you are interested in the position and wish to apply, kindly forward the following documents: A curriculum vitae.Certified copies of qualifications and identity document.To this Email: vacancies@shellybeachhospital.com THE CLOSING DATE FOR APPLICATIONS IS THE 03rd January 2025 AT 16H00.
NO LATE APPLICATIONS WILL BE CONSIDERED. POPIA CLAUSE: Your information is collected and processed in accordance with the Protection of Personal Information Act No 4 of 2013 (POPIA).
By applying to this advert, you consent to Shelly Beach Hospital collecting and processing your personal information for the purpose of determining your eligibility for the advertised position.
If unsuccessful, your personal information will be securely destroyed and not retained by the company.
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