A vacancy exists for a Case Manager Specialised, based at Life Fourways Hospital, reporting to Patient Services Manager. The successful candidate will be responsible for the management of the financial and clinical administrative risks pertaining to patients in specialised units – Intensive care units, high care units and neonatal intensive care units.Critical OutputsEnsuring operational excellence by:Conducting ward rounds and ensuring the accurate complete collection of clinic data from patient files and liaisons with nursing staff and attending clinicians.Updating accurate clinical information to justify length of stay and level of care to medical funds of specialised unit cases and where operationally required general ward cases.Updating and providing the necessary information to funders regarding high value items, limited benefits and protocols as defined by managed care organizations.Communicating funder requirements/responses to attending clinicians and patients where necessary, and ensuring compliance with industry standards.Ensuring effective management of real time and manual messaging, including requests, responses, rejections and submissions.Ensuring the accurate submission of accounts to funders.Complying with governance and risk management requirements by ensuring adherence to patient services policies and procedures.Ensuring compliance to service level agreements with internal and external stakeholders.Ensuring effective management of revenue by:Ensuring the accurate and complete coding of patient accounts.Ensuring the correct application and correct interpretation of funder RSRT contracts and FFS claims.Reporting RSRT risks identified to the relevant manager.Ensuring effective management of quality outputs by:Adhering to patient services escalation processes and customer services standards.Investigating and reporting published alerts incidents and agreeing upon appropriate action with internal and external stakeholders.Ensuring effective management of relationships with internal/external stakeholders by:Building and maintaining relationships with internal stakeholders.Providing and facilitating training regarding RSRT contracts.Providing feedback and information regarding concerns or issues raised by external stakeholders.Providing feedback on external stakeholders impacting on the efficiency and effectiveness of the case management process.Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings.RequirementsDiploma 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.Experience including proven leadership, change and people management.Current registration with the relevant professional/regulatory body (South African Nursing Council).Understanding of clinical coding, clinical terminology and anatomy, funder rules, co-payments and exclusions.Working knowledge of COID.Understanding of business and change management principles.Computer proficiency.CompetenciesProblem-solving, analysis and judgement.Resilience.Engaging diversity.Verbal & written communication and presentation.Influencing.Drive & energy.Excellence orientation.Ethical behaviour.Building relationships.Customer responsiveness.Organisational awareness.Leading by example (Key for Managers).Motivating and developing people (Key for Managers).Email: ****** date: Friday, August 23, 2024.Internal 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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