A vacancy exists for a Case Manager General based at Life Wilgers Hospital, reporting to the 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.
FunctionPatient services
FacilityLife Wilgers Hospital PositionGeneral Case Manager
Critical OutputsEnsuring the maximisation of revenue byEnsuring 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 byPerforming 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 byMonitoring submission of accurate accounts to fundersUpdating length of stay and level of care to medical aidsReleasing care risk targets and submission within two days of dischargeEnsuring the 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 byBuilding 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 Care Risk Managers with external stakeholdersEscalating doctor non-compliance in terms of RSRT framework to RSRT meetingsRequirementsNursing Qualification, Professional Nurse with at least three to five years' experienceCurrent 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 behaviourEmail: ****** Closing date: Saturday, August 31, 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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