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.


 

 

 

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