Case Manager

Assess patient conditions and needs to develop appropriate care plans

Interact with patients and medical aid schemes

Resolve patient and medical aid scheme queries

Update all information timeously and accurately

CPT and ICD coding

Obtain doctors letters, motivations, and justifications in all appropriate cases under managed care of where medical aids request them from their hospitals as part of their assessing process

Monitor patient admissions and identify those who have limitations, restrictions, place by their managed care/ medical aid structures e.g. length of stay, cost restrictions, fixed fees, per diem and other limiting fees or drugs and/ or formularies

Maintain a control system that ensures the systematic monitoring of managed care patients

Handling patient queries

Update hospital information

Qualified Registered Nurse

Minimum 3 years nursing experience in a multidisciplinary hospital.

Experience and exposure in Theatre and/or ICU would be advantageous

Hospital or Medical Aid scheme case management would be an advantage.

Experience in ICD 10 and CPT coding is essential

Knowledge of Prescribed Minimum Benefits (PMB) Scheme rules and policies

Excellent communication skills (written and spoken)

Excellent analytical and problem-solving skills

Excellent MS Office computer skills, i.e. Outlook, Word, Excel, Kronos, Clinic Manager, etc.

Attention to detail

Ability to cope well under pressure