Manager Hospital Durban - eThekwini
Resource Associates
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. 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 the NHN Managed Health Care rules of engagement. • Compliance with all industry relevant legislative acts, regulations and circulars ESSENTIAL QUALIFICATIONS INCLUDE: B Degree/Diploma Nursing qualification Case Management qualification AN ADDED ADVANTAGE Case Management experience ICD-10 / CPT Coding Qualification AND/or Experience SAP IS-H experience advantageous Proficiency in Microsoft Office products
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