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    hospital case manager - Cape Town, South Africa - Premium Consulting

    Premium Consulting
    Premium Consulting Cape Town, South Africa

    1 day ago

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    Description

    CASE MANAGER

    REQUIREMENTS:

    • Qualified Registered Nurse
    • A qualified EN with relevant experience would be considered
    • Both need to registered with SANC and proof of indemnity cover
    • Minimum 3 years nursing experience in a multidisciplinary hospital.
    • Experience and exposure in Theatre and/or ICU would be advantageous
    • Hospital or Medical Aid scheme case management would be an advantage.
    • Experience in ICD 10 and CPT coding is essential
    • Knowledge of Prescribed Minimum Benefits (PMB) Scheme rules and policies
    • Excellent communication skills (written and spoken)
    • Excellent analytical and problem-solving skills
    • Excellent MS Office computer skills, i.e. Outlook, Word, Excel, Kronos, Clinic Manager,
    • Attention to detail
    • Ability to cope well under pressure

    KEY OUTPUTS:

    • Assess patient conditions and needs to develop appropriate care plans
    • Interact with patients and medical aid schemes
    • Resolve patient and medical aid scheme queries
    • Update all information timeously and accurately
    • CPT and ICD coding
    • Obtain doctors letters, motivations, and justifications in all appropriate cases under managed care of
    • where medical aids request them from their hospitals as part of their assessing process
    • Monitor patient admissions and identify those who have limitations, restrictions, place by their managed
    • care/ medical aid structures e.g. length of stay, cost restrictions, fixed fees, per diem and other limiting
    • fees or drugs and/ or formularies
    • Maintain a control system that ensures the systematic monitoring of managed care patients
    • Handling patient queries
    • Update hospital information
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