Life Health Vacancies – Case Manager General Ward

Website Life Healthcare

Job Description:

A vacancy exists for a Case Manager General Ward based at Life St. Dominic’s Hospital, reporting to Patricia Barlow, Patient Services Manager. The successful candidate will be responsible for managing the financial and clinical risks of the patient in a general ward by ensuring accurate coding, clinical updates and accounts submissions of patient hospitalization to achieve strategic objectives.

Job Responsibilities:

  • Adhering to patient services escalation processes in order to achieve QMS targets
  • Monitoring Q-evaluator scores and implementing corrective measures
  • Participating in meetings and reporting losses to RSRT team and recommend corrective actions
  • Monitoring insurance verification and workflow processes
  • Updating length of stay and level of care to funders of general ward cases and where operationally required specialised unit cases.
  • Releasing care risk targets and submission within two days of discharge
  • Ensuring accuracy of coding
  • Ensuring the correct application and interpretation of RSRT’s
  • Investigating internal and external stakeholder complaints
  • Ensuring the adherence to customer service standards
  • Ensuring the compliance to LHC policies and managing authorisations and claim submissions, rejections and delays
  • Ensuring governance and risk management by monitoring and adhering to patient services policies and procedures
  • Ensuring compliance to service level agreements with internal and external stakeholders
  • Performing quality walkabouts and implement corrective measures
  • Implementing and monitoring quality improvement programmes

Job Requirements:

  • Knowledge of Funder contracts, scheme rules, exclusions and benefits
  • Understanding of private hospital industry and practices
  • Knowledge of hospital patient services and case management processes
  • Knowledge and understanding of CPT & ICD coding
  • Computer proficiency

Qualification & Experience:

  • Nursing Qualification, preferably Professional Nurse with at least three years’ experience or Enrolled Nurse with proven case manager and clinical coding experience of at least 3 -5 years.
  • Current SANC registration

Job Details:

Company: Life Healthcare

Vacancy Type: Full Time

Job Location: East London, Eastern Cape, South Africa

Application Deadline: N/A

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