Case Manager | General Ward – Mzansi Youth Jobs

Job Listing: Case Manager | General Ward

Position: Case Manager | General Ward
Facility: Life The Crompton Hospital
Department: Patient Services
Reporting To: Praviksha Bailey, Finance and Admin Manager

Overview

We are excited to announce an opening for a Case Manager in the General Ward at Life The Crompton Hospital. The successful candidate will play a key role in managing both the financial and clinical aspects of patient care. You will ensure that all patient hospitalizations are accurately coded, and clinical updates are completed in a timely manner. Your work will be vital in helping us achieve our strategic goals and improve patient services.

Key Responsibilities

Maximizing Revenue

Ensure the accuracy of coding for all patient services.
Apply and interpret RSRT (Reimbursement Strategy and Reporting Tool) guidelines correctly.
Attend team meetings to report any losses to the RSRT team and suggest corrective actions.
Monitor the insurance verification process and workflow to ensure efficiency.

Enhancing Quality of Care

Conduct regular quality assessments and implement corrective actions as needed.
Participate in and oversee quality improvement initiatives.
Follow patient service escalation processes to meet Quality Management System (QMS) targets.
Track Q-evaluator scores and make necessary adjustments.
Investigate complaints from internal and external stakeholders to improve service delivery.
Maintain high standards of customer service throughout the patient care process.

Achieving Operational Excellence

Ensure that accurate accounts are submitted to funding bodies in a timely manner.
Update length of stay and level of care for general ward cases, and specialized unit cases when necessary.
Meet care risk targets and submit documentation within two days of patient discharge.
Comply with all Life Healthcare policies, managing authorizations, claims submissions, and addressing any rejections or delays.

Governance and Risk Management

Monitor adherence to patient services policies and procedures to ensure governance.
Comply with service level agreements with both internal and external stakeholders.
Ensure all billing checks are completed by the relevant areas.

Building Relationships

Foster and maintain relationships with internal stakeholders to improve communication and workflow.
Address any concerns or issues raised by internal stakeholders promptly.
Provide training about RSRT contracts to relevant team members.
Maintain effective communication with external stakeholders.
Manage escalated issues from Case Managers regarding external stakeholders.
Bring any instances of doctor non-compliance with the RSRT framework to RSRT meetings.

Qualifications

A diploma or degree in Nursing, Physiotherapy, Clinical Associates, Paramedics, Critical Care Assistants, Emergency Care Practitioners, or a similar qualification that includes Anatomy, Physiology, Pathophysiology, and Microbiology.
Current registration with SANC (South African Nursing Council).
Understanding of hospital patient services and case management processes.
Familiarity with CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) coding.
Knowledge of Funder contracts, scheme rules, exclusions, and benefits.
A good grasp of practices in the private hospital industry.
Proficiency in computer skills.

Required Skills and Competencies

Strong attention to detail.
Effective problem-solving and analytical skills.
Ability to handle challenges with resilience.
Capacity to engage with a diverse range of individuals.
Strong verbal and written communication skills.
Professional and technical expertise.
Ability to build and maintain relationships.
Commitment to customer responsiveness.
Awareness of organizational dynamics.
Influencing and negotiation skills.
Results-oriented with a focus on excellence.
Upholding ethical standards in all activities.

How to Apply

Interested candidates are encouraged to download the application form using the following link: Download Application Form. Please complete the form and submit it along with your CV.

Email Your Application To: Keshree.Govender@lifehealthcare.co.za

Closing Date: Friday, September 13, 2024

Internal applicants should discuss their application with their line manager prior to submission. External candidates are also welcome to apply.

Life Healthcare is an Equal Opportunity Employer. We appreciate your interest in this position. Please note that only candidates who are shortlisted will be contacted. If you have not received a response within two weeks of the closing date, please consider your application unsuccessful.

Thank you for considering a career with us!