Case Manager

SUMMARY:
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POSITION INFO:

Job Summary:
Case Manager
Clinix Dr SK Matseke Memorial and Tshepo – Themba hospitals
Patient Services Manager
To plan, coordinate and execute case management work at hospital level. The incumbent utilises clinical
knowledge to minimise financial risk and ensure accurate billing through comprehensive accurate coding
of patient care.
This is a short-term contract position, to begin in May 2025.
Minimum Requirements:
• Diploma in Nursing
• 5 years’ experience as a hospital case manager
• Knowledge of ICD-10 and CPT Coding
• Knowledge of private health care operations
• Attention to detail and ability to confirm accuracy of files
Minimum work experience:
• Ensure compliance to case management procedures, standards and protocols.
• Plan, coordinate and execute Clinical coding in accordance with relevant CHG standards and
protocols.
• Timeously and consistently communicate and follow up with Funders (Medical Aids, COID,
Government, RAF, DOL, etc.)
• Provide appropriate clinical information to Funders in order to update Length of Stay, Level of
Care, formulary utilisation, assistive devices / Prosthesis, diagnostic interventions, therapy
intervention and procedural interventions and any required changes in patient treatment.
• Investigate and understand Funder, Doctors, Nurses and Patient needs to enable delivery of a
quality service.
• Ensure timeous resolution of stakeholder queries and complaints and take ownership of case
management and reimbursement related issues.
• Escalate potential risks that may lead to increased costs or financial losses.
• Maintain accurate records of patient care and timeously submit to funders to ensure the
organisation is appropriately reimbursed for all services rendered.
• Liaise with the Billing department with regards to conversion of medical aid patients to cash
patients.
• Adhere to statutory standards, policies and procedures within the business unit to ensure
compliance at all times and take remedial action where necessary. 

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