Case Manager

• 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

Post Requirements:

• B Degree/Diploma Nursing qualification and/or Case Management qualification
• Diverse clinical nursing experience
• Case Management experience
• ICD-10 / CPT Coding Qualification or Experience
• SAP IS-H experience advantageous
• Proficiency in Microsoft Office products