Registered Nurse and currently registered with the SA Nursing Council (SANC).
Alternatively, an Enrolled Nurse currently registered with SANC.
Certificate in Coding (advantageous).
3-5 years’ experience in a private hospital or Medical Scheme environment in a case management capacity.
Working knowledge of ICD-10 and CPT codes.
Computer literate – SAP System of similar.
Ensure authorizations on admissions (daily) is accurate as per SAP system.
Conduct daily case management rounds in allocated units to obtain updated clinical information from patient files.
Conduct daily case management rounds in allocated units to obtain updated clinical information from patient files. Comply with case management procedures, Medical Scheme contracts and legal aspects by utilizing available resources and systems (specifically the Case Manager Workstation on SAP).
Communicate consistently and timeously with the Medical Schemes as contractually agreed through the relevant case management channels.
Obtain Doctors letters of motivation in support of all cases where Medical Schemes request these from the hospital as part of their assessing process.
Minimize financial risk by effectively managing patient stay.
