Case Manager

REQUIREMENTS:

Qualified Registered Nurse
Registration with SANC and proof of indemnity cover
Minimum 2 years' experience
Previous experience in a private hospital would be advantageous
Knowledge of ICD 10 and CPT coding
Knowledge of Prescribed Minimum Benefits (PMB) Scheme rules and policies
Medical-aid background in Case Management Department
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 OUTPUTS:

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 as part of their assessing process.
Monitor patient admissions and identify those who have limitations and restrictions imposed 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.
Handling patient queries.
Update hospital information.

Interested applicants are requested to submit an updated, comprehensive CV to ******.

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