Hospital Case Manager at MHR

Requirements

• Must be available immediately
• Registered with the South African Nursing Council as a Registered Nurse or with the HPCSA as a qualified paramedic
• Experience in Theatre and or ICU serves as an advantage (Enrolled and Professional Nurse)
• Experience as an ALS Paramedic is essential (Paramedic)
• Case management experience is essential
• Experience in private healthcare environment
• Knowledge of the Scientific Nursing Process and associated procedures
• Knowledge of the rules and regulations regarding medical aid schemes
• Knowledge of clinical codes and coding policies
• Knowledge of patient administration systems, policies and procedures
• Proficient in Microsoft Office (Word, Excel and Outlook)
• Independent problem-solving and decision-making skills
• Good accuracy and attention to detail skills in order to maintain high standards of work output

Key Outputs

• Responsible for the case management processes
• Interacts with medical schemes to ensure that authorisations are provided timeously
• Verification of clinical coding as per policies and procedures
• Ensures accurate application and interpretation of specialised wards criteria
• Provides support for the management of alternative fee structures
• Liaison with doctors on funder requirements when necessary
• Continuous performance and quality management
• Interpretation and implementation of scheme benefit rules
• Maintains client service principles to ensure client expectations are met