Mediclinic Southern Africa is a healthcare provider operating in South Africa and Namibia focused on providing acute care, specialist-orientated, multidisciplinary hospital services and related service offerings. We place science at the heart of our care process by striving to provide evidence-based care of the highest standard. The group currently operates 50 private hospitals (excluding a growing number of day clinics) throughout South Africa and three hospitals in Namibia with more than 8 200 beds in total.MAIN PURPOSE OF JOBTo coordinate the hospital case management process and facilitate the communication process between all role players by providing accurate and timeous clinical information to minimise the financial risk for the organisation.KEY RESPONSIBILITY AREASMinimise financial risk by effectively managing patient stay.Ensure compliance to case management procedures, contracts and legal aspects by utilising available resources and systems.Ensure correct and timeous finalisation of cases to facilitate reimbursements from funders of claims.Consistently and timeously communicate with Funders as contractually agreed through the relevant case management channels.Ensure clinical coding standards are adhered to as per Level 3 coding guideline.Lead and manage the people in the Case Management team (if applicable).REQUIRED EDUCATIONESSENTIAL EDUCATION: Clinical qualification.DESIRED EDUCATION: Registered Nurse / Professional Nurse or qualified Paramedic.REQUIRED EXPERIENCEESSENTIAL MINIMUM EXPERIENCE: Minimum of 3 years in a clinical role.DESIRED EXPERIENCE: Experience in Theatre and or ICU; Medical aid background; Experience in private healthcare environment or experience as an ILS/ALS Paramedic.REQUIRED JOB SKILLS AND KNOWLEDGEAnatomy; physiology and terminology.Funder Contracts; Medical aid requirements/narrations.Scientific nursing principles and process.B2B EMS (electronic message system: check status of authorisations and use for troubleshooting).Computer literate (Microsoft Office).Authorisation and motivation of Level of Care; Length of Stay; Short Payments etc.Relevant aspects of applicable statutory acts (e.g. Consumer Protection Act; PMB; etc.).Patient Administration policies and procedures (e.g. Patient Confidentiality; Visitation of external case managers; etc.).Daily workflow; managing deviances; coding; and case management processes.Application of clinical codes and finalisation thereof (Level 3 coding).Patient admin programmes on the AS400 system.
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