The Case Manager utilising clinical knowledge and expertise, mitigates financial risk through comprehensive and accurate coding of hospital events, communication with funders on justification for hospitalisation level of care and length of stay.
Key Performance Areas: (include but are not limited to)
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 cases for billing.
Liaise with a network of internal and external stakeholders regarding patient treatment.
Adhere to the Managed Health Care rules of engagement.
Compliance with all industry relevant legislative acts, regulations and circulars
Good communications and interpersonal skills
Post Requirements: (include but are not limited to)
B Degree/Diploma Nursing qualification and/or Case Management qualification