Case Manager

Minimum Qualifications:Qualified Registered NurseA qualified EN with relevant experience would be consideredBoth need to be registered with SANC and provide proof of indemnity coverExperience Requirements:Minimum 3 years nursing experience in a multidisciplinary hospital.Experience and exposure in Theatre and/or ICU would be advantageous.Hospital or Medical Aid scheme case management would be an advantage.Experience in ICD 10 and CPT coding is essential.Knowledge of Prescribed Minimum Benefits (PMB) Scheme rules and policies.Excellent communication skills (written and spoken).Excellent analytical and problem-solving skills.Excellent MS Office computer skills, i.e.
Outlook, Word, Excel, Kronos, Clinic Manager, etc.Attention to detail.Ability to cope well under pressure.Key Responsibilities:Assess patient conditions and needs to develop appropriate care plans.Interact with patients and medical aid schemes.Resolve patient and medical aid scheme queries.Update all information timeously and accurately.CPT and ICD coding.Obtain doctors' letters, motivations, and justifications in all appropriate cases under managed care or where medical aids request them from their hospitals as part of their assessing process.Monitor patient admissions and identify those who have limitations or restrictions placed by their managed care/medical aid structures, e.g., length of stay, cost restrictions, fixed fees, per diem, and other limiting fees or drugs and/or formularies.Maintain a control system that ensures the systematic monitoring of managed care patients.Handle patient queries.Update hospital information.
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