Two (2) vacancies exist for Case Managers - General Wards based at Life Flora Hospital, reporting to Trust Pandor, Patient Services 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 hospitalization to achieve strategic objectives.Critical OutputsEnsuring the maximisation of revenue by:Ensuring accuracy of codingEnsuring the correct application and interpretation of RSRT'sParticipating in meetings and reporting losses to RSRT team and recommend corrective actionsMonitoring insurance verification and workflow processesEnsuring effective management of quality outputs by:Performing quality walkabouts and implement corrective measuresImplementing and monitoring quality improvement programmesAdhering to patient services escalation processes in order to achieve QMS targetsMonitoring Q-evaluator scores and implementing corrective measuresInvestigating internal and external stakeholder complaintsEnsuring the adherence to customer service standardsEnsuring operational excellence by:Monitoring submission of accurate accounts to fundersUpdating length of stay and level of care to funders of general ward cases and where operationally required specialised unit cases.Releasing care risk targets and submission within two days of dischargeEnsuring compliance to LHC policies and managing authorisations and claim submissions, rejections and delaysEnsuring governance and risk management by monitoring and adhering to patient services policies and proceduresEnsuring compliance to service level agreements with internal and external stakeholdersEnsuring all billing checks are closed by the relevant function areasEnsuring effective management of relationships with internal/external stakeholders by:Building and maintaining relationships with internal stakeholdersProviding feedback and information on concerns or issues raised by internal stakeholdersProviding and facilitating training regarding RSRT contracts to the relevant internal stakeholdersEnsuring effective communication with external stakeholdersManaging escalated concerns from Case Managers with external stakeholdersEscalating doctor non-compliance in terms of RSRT framework to RSRT meetingsRequirementsDiploma 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.Current SANC registrationKnowledge of hospital patient services and case management processesKnowledge and understanding of CPT & ICD codingKnowledge of Funder contracts, scheme rules, exclusions and benefitsUnderstanding of private hospital industry and practicesComputer proficiencyCompetenciesAttention to detailProblem-solving, analysis and judgementResilienceEngaging diversityVerbal & written communication skillsProfessional and technical proficiencyBuilding relationshipsCustomer responsivenessOrganisational awarenessInfluencing skillsAction orientationExcellence orientationEthical behaviourTel: 011 470 7881Email: ****** date: Wednesday, September 18, 2024Internal applicants - Before making an application, you are requested to discuss your application with your line manager. External candidates will also be considered.Life Healthcare is an Equal Opportunity Employer.Thank you for your interest in this opportunity. Kindly note that only shortlisted candidates will be contacted. Applicants who have not been contacted within two weeks of the closing date of this advert should consider their application as unsuccessful.
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