General Case Manager - Life Healthcare in Gauteng

Job Title: Case Manager - General

Function:
Patient Services

Facility:
Life Little Company of Mary Hospital, Tshwane

Introduction:
A vacancy exists for a Case Manager – General at Life Little Company of Mary Hospital reporting to the Patient Services Manager. The successful candidate will be responsible for managing the financial and clinical risks of the patient event by ensuring accurate coding, clinical updates and accounts submissions of patient hospitalization to achieve key strategic objectives.

Critical Outputs:
Maximization of correct revenue
Drive and ensure correct application and correct interpretation of RSRT’s, accuracy of coding and compliance to Company policies regarding authorisations.
Manage and monitor input on IMEDS system, manage re-authorisations rejections and delays, monitor insurance verification, submission of accurate accounts to Funders and adhoc reports.
Report losses to RSRT team and recommend corrective actions.
Ensure timeous update of patient events as per protocol.
Effective management of quality outputs
Adhere to ISO 9001 standards and patient escalation processes.
Implement and monitor quality improvement programs through relevant stakeholders. Ensure adherence to customer service standards and investigate complaints.
Operational excellence
Submit correctly coded, updated and re-priced accounts according to patient services protocol.
Respond promptly on all accounts, queries, and motivation letters required and short payments.
Document risk analysis, recommendations and implement changes.
Monitor and adhere to patient services policies and procedures.
Effective management of relationships with internal/external stakeholders
Ensure compliance to SLA’s with internal stakeholders, foster healthy relationships, report and escalate problematic issues to line manager and provide relevant feedback and information on concerns or issues raised.
Escalate non-compliance in terms of RSRT framework to line manager.

Requirements:
Nursing Qualification i.e. Enrolled Nurse or Registered Nurse with at least 3 to 5 years experience (exposure to Care Risk Management in a hospital or funder environment is preferable).
Clinical competency skills (ability to extract relevant data relating to acuity level of cases)
Basic understanding of clinical terminology and a certificate in anatomy and physiology.
Clinical coding (having achieved industry competency level).
Comprehensive knowledge of funder contracts, funder rules, co-payments and exclusions.
Computer proficiency.

Contact:
Interested candidates who meet the requirements are invited to apply by forwarding a comprehensive CV to the contact person by close of business on 27 May 2013:
Stephanie Barnard
Patient Service Manager
Tel : (012) 4243714
Fax : (086) 679 3732
stephnie.barnard@lifehealthcare.co.za

How to apply:
http://www.lifehealthcare.co.za/Careers/Careers/JobInfo.aspx?Vacancy_Id=6393&vVacancyAllDir=Asc&s_Categories_Id=12#JobInfo

Deadline: 27 May 2013