Procedure Case Manager

Recruiter:

Greys Personnel

Job Ref:

PE000593/LP

Date posted:

Wednesday, July 6, 2022

Location:

Sandton, South Africa

SUMMARY:
My client a Managed Care Organization registered with the Council of Medical Schemes to manage healthcare risks.
The office is based in Parktown North, Johannesburg.

Purpose of Position:
This position performs the comprehensive and effective review, assessment, and management of hospital and prosthesis company billing practices.

JOB DESCRIPTION:

Person Specifications:
This position is best suited to an experienced Orthopaedic Scrub Sister, or an Orthopaedic nurse or Theatre Matron who can:

Effectively work with a healthcare team of surgeons and their administrators to manage the quality of care to a patient.
Produce work of high quality by accurately managing processes and tasks.
Communicate effectively to all our stakeholders, i.e., surgeons, patients, and staff.
Knowledge of Afrikaans (spoken and written) will be an advantage.

Qualifications, Experience, and Knowledge:

Qualification in Nursing - Diploma, BA(Cur)
Registered with SANC.
Qualification and Experience in Theatre are essential
Speciality Training/Qualification and Experience a ward would be an advantage.
2-5 years of experience is essential.
Experience in practice management will be an advantage.
Experience in managing patient care activities in a medical practice or hospital facility.
Exposure to medical billing and prothesis management
Excellent communication skills to promote effective interactions with all stakeholders, i.e., surgeons, patients, staff, and the public.

Key Accountabilities:
Customer Relationship Management

Induction of surgeons and their rooms regarding the ICPS pathway and clinical guideline protocols.
Development and training of ICPS Network surgeons and their administrators in the use of the ICPS website registration process.
Funder relations regarding scheme queries, member queries, carve-outs in adverse events.
Attend to queries from Suppliers, Funders, and Members.
Marketing the ICPS pathway to non-network surgeons and their administrators.
Marketing the ICPS pathway to patients requiring cataract surgery.
Schedule and conduct six monthly or yearly visits to practices.
Induction of ICPS processes to hospitals and hospital patient administrators.
Measuring, monitoring, and managing compliance to the ICPS pathway.
Maintain a provider and supplier contact list and address book.
Liaise and manage prosthesis ordering, supply, and billing.
Establish a relationship with suppliers of services.

Clinical Data Management

Assisting with clinical systems development
Manage the quality of the data captured on the ICPS registration system.
Providing quarterly clinical governance reports to the board
Data collecting and root cause analysis of adverse events, complications, and carve out cases.

Clinical Case Management

Managing the authorization of surgery
Confirmation of admission and discharge dates of patients
Monitoring in-hospital stay (clinical update via email) and managing service level agreement violations.

Cost Management

Review supplier bills for accuracy of charges and unusual item utilization.
Measuring and reporting on billing and utilization trends.
Managing the relationship and cost profile with MMED.

NB! This job is now closed. You can apply for other jobs by uploading your CV.

Similar jobs you might be interested in:

Warehouse Supervisor
Location: Pretoria
Salary: R270K TCTC plus shift allowance and overtime
Centurion
6 days ago

Project Manager
Location: Johannesburg
Salary:
We are looking for a mature, energetic, well-organized and highly capable IT Project manager who will be responsible for the management of moderate to highly complex programs consisting of multiple related projects. Oversee major projects, providing strategic context, direction and leadership to the teams involved. Monitor project execution plans, resource deployment and overall coordination effor...
18 days ago

Production Manager
Location: Isando
Salary: Market related
The purpose of this role is to enable achievement of Production targets.
25 days ago

General Manager
Location: Midrand
Salary:
3 days ago

IR Specialist at Law Firm in Pretoria
Location: Pretoria
Salary: R15 000.00 Monthly
Law firm is looking for an experienced IR specialist
10 days ago

Project Manager & Business Analyst
Location: Pretoria
Salary: MR Monthly
Our Client is looking for a Project manager & Business Analyst to join their team
5 days ago

Financial Manager
Location: Johannesburg
Salary:
A Financial manager is needed!
7 days ago

Test Specialist (Business Analyst) - 2788
Location: Pretoria
Salary: Hourly
Do you thrive in a dynamic, collaborative environment? Our client, a leading global organization in the automotive industry, is seeking a Test Automation Specialist to join their team.
11 days ago

Junior Business Analyst
Location: Johannesburg
Salary:
11 days ago

Payment Architect / Lead Solutions Architect
Location: Johannesburg
Salary:
Our client in the banking sector seeks to employ a Payments Architect to support the payments value stream to transform and modernize our payments landscape with expertise in Microservices and Cloud Technologies. This will be a challenging role in a fast-paced environment but will be a rewarding process to drive change from both a strategic roadmap and solution design perspective.
12 days ago

Procedure Case Manager

Similar jobs you might be interested in:

Create a free job alert for Procedure Case Manager in Sandton

Jobseekers

Recruiter

General