Avacancy exists for a Case Managers – General at Life Groenkloof Hospital reporting to the Patient Services Manager. The successful candidate will be responsible for managing the financial and clinical risks of the patient event by ensuring accurate coding, clinical updates, and accounts submissions of patient hospitalization to achieve key strategic objectives.Critical OutputsMaximization of correct revenueDrive and ensure correct application and correct interpretation of RSRT's, accuracy of coding and compliance to Company policies regarding authorisations.Manage and monitor input on IMEDS system, manage re-authorisations rejections and delays, monitor insurance verification, submission of accurate accounts to Funders and adhoc reports.Report losses to RSRT team and recommend corrective actions.Ensure timeous update of patient events as per protocol.Effective management of quality outputsAdhere to ISO 9001 standards and patient escalation processes.Implement and monitor quality improvement programs through relevant stakeholders. Ensure adherence to customer service standards and investigate complaints.Operational excellenceSubmit correctly coded, updated, and re-priced accounts according to patient services protocol.Respond promptly on all accounts, queries, and motivation letters required and short payments.Document risk analysis, recommendations and implement changes.Monitor and adhere to patient services policies and procedures.Effective management of relationships with internal/external stakeholdersEnsure compliance to SLA's with internal stakeholders, foster healthy relationships, report and escalate problematic issues to line manager and provide relevant feedback and information on concerns or issues raised.Escalate non-compliance in terms of RSRT framework to line manager.RequirementsNursing Qualification i.e. Registered Nurse with at least 3 to 5 years experience (exposure to Care Risk Management in a hospital or funder environment is preferable).Clinical competency skills (ability to extract relevant data relating to acuity level of cases)Basic understanding of clinical terminology and a certificate in anatomy and physiology.Clinical coding (having achieved industry competency level).Comprehensive knowledge of funder contracts, funder rules, co-payments and exclusions.Computer proficiency.CompetenciesProblem-solving, analysis and judgementResilienceEngaging diversityVerbal & written communication and presentationInfluencingDrive & energyExcellence orientationEthical behaviourBuilding relationshipsCustomer responsivenessOrganisational awarenessLeading by example (Key for Managers)Motivating and developing people (Key for Managers)Email: ****** date: Thursday, September 12, 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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