Case Manager (Hospital Group) - Randfontein, Gauteng

Updated: April 23, 2024 12:47 AM GMT

Glasshouse Recruiting

Randfontein

Introduction

Requirements:
• B degree/diploma nursing qualification and/or Case Management qualification
• Diverse clinical nursing experience
• Case Management experience
• ICD-10 / CPT coding qualification or experience
• SAP IS-H experience
• Proficiency in Microsoft Office

Duties & Responsibilities:
• Responsible for application of clinical knowledge in justifying patient hospitalisation in terms of treatment, length of stay and level of care
• Monitor and action risk related to medical aid benefits and hospitalisation
• Ensure accurate, specific and comprehensive clinical coding
• Timeous, effective communication and follow-up with medical aids
• Review authorisation aspects approved, mitigating financial risk and final releasing the case for billing
• Liaise with a network of internal and external stakeholders regarding patient treatment
• Adhere to NHN Managed Health Care rules of engagement
• Compliance with all industry legislative acts, regulations and circulars More Detail