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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