Case Manager – RN/PN

Job Title: Case Manager – RN/PN

Recruiter:
Immploy

Job Reference:
CPT002960/LG

Date Posted:
Thursday, September 26, 2024

Location:
Pietermaritzburg, South Africa

Overview:

Are you a dedicated and experienced healthcare professional looking for a fulfilling role that allows you to make a real difference in patient care? We have an exciting opportunity for you! A private hospital in Pietermaritzburg is on the lookout for a skilled Case Manager. This role is crucial as you will be reporting directly to the Finance Manager, ensuring that patients receive efficient case management while providing high-quality service to both internal and external customers.

As a Case Manager, your primary goal will be to streamline the patient care process, enhancing the experience for everyone involved. You will be the vital link between the hospital and its patients, managing their needs and concerns throughout their hospital stay. Your expertise will ensure that patients are well-informed, and their cases are managed effectively to minimize financial risks.

Key Responsibilities:

In this pivotal role, you will be entrusted with a variety of important tasks, including but not limited to:

• Clinical Coding: You will carry out clinical coding that adheres to CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) requirements. Accurate coding is essential for ensuring proper documentation and reimbursement for services rendered.
• Pre-Admission and Pre-Authorization: It’s crucial to ensure that all pre-admission and pre-authorization information is accurate and complies with hospital and funder procedures. You will be responsible for collecting and verifying this information before patient admission, which helps facilitate a smooth and efficient hospital experience.
• Patient Clinical Status: During the patient’s stay, you will maintain their clinical status according to funder approval requirements. This includes keeping patients informed about their progress and addressing any financial risks associated with their hospitalization.
• Account Management: Providing complete and accurate updates on discharge information and all accounts is another essential part of your job. You will ensure that all patient admissions are accurately recorded and that their medical files are managed according to hospital procedures.
• Electronic Submission of Accounts: You will be responsible for the timely electronic submission of accounts, following up on any short payments related to case management issues. Quick follow-ups are vital to resolving any billing discrepancies efficiently.
• Staff Compliance: Ensuring that hospital staff adhere to funder rules and coding procedures is key to maintaining the integrity of the hospital’s operations. You will work closely with your colleagues to provide training and resources to help them understand and comply with these rules.
• Legislation Knowledge: Staying informed about current legislation pertaining to funders and related healthcare matters is essential. Your knowledge will help ensure that the hospital remains compliant with regulations and that patients receive the best possible care.

Minimum Requirements:

To be considered for this role, candidates must meet the following minimum requirements:

• SANC Registration: You must be registered with the South African Nursing Council (SANC) as a Registered Nurse (RN) or an Enrolled Nurse (PN). This certification validates your qualifications and ensures that you are legally able to practice in South Africa.
• Experience: A minimum of five years of experience as a case manager is required, ideally in a hospital setting or with medical schemes. This experience is crucial for understanding the complexities of patient care and case management.
• Medical Aid Knowledge: Familiarity with medical aid administration procedures, including ICD10, CPT 4 procedure codes, and per diems, is essential. Your understanding of these procedures will allow you to navigate the healthcare system more effectively.
• Hospital Billing Knowledge: Knowledge of hospital billing practices and tariffs, as well as experience with Hospital Information Systems (HIS), will be an advantage. This understanding helps in accurate billing and coding, ensuring that the hospital receives proper compensation for services rendered.
• Interpersonal Skills: You must possess the ability to build strong relationships with various internal and external stakeholders. Strong interpersonal skills are essential for effective communication and collaboration within the healthcare team and with patients and their families.

Why This Role is Important:

The Case Manager plays a vital role in ensuring that patients receive the care they need while navigating the complexities of healthcare billing and insurance. By efficiently managing patient cases, you will help reduce confusion and financial strain for patients and their families. Your work will not only improve patient satisfaction but also contribute to the overall success of the hospital.

As a Case Manager, you will have the opportunity to make a positive impact on the lives of patients. Your efforts will ensure they understand their treatment plans, financial responsibilities, and the resources available to them during their hospital stay. This role is not just about managing cases; it’s about being an advocate for patients, ensuring they receive the care and attention they deserve.

Application Process:

If you are ready to take on this rewarding role and contribute to the quality of patient care in Pietermaritzburg, we encourage you to apply! Join a dedicated team committed to providing exceptional service and making a real difference in the lives of patients.

To apply for the Case Manager position, please visit this link and submit your application. We look forward to welcoming you to our team!