Case Manager Professional Nurse

  • Main Purpose of the Job: 
    • Check confirmations for L.O.S and L.O.C relative to each patient
    • Assess patient clinical reports for communication to Medical Aids
    • Process updates with Medical Aid for each patient
    • Intermediate/ Advanced competency of ICD 10 and CPT coding.
    • Check all ICD, CPT Coding and authorization numbers
    • Handle communication and queries with Medical Aid Case Managers
    • Assist Patients/Doctors with patients requiring step down facilities
    • Liaising with Doctors, Nursing Staff and Patients
    • Liaising with the Debtors Department regarding any queries
    • Release and submit accounts timeously

     

    Education, experience and competencies required

    • Strong Administration skills
    • Previous Case Manager experience required
    • Nursing experience in ICU & NNICU an added advantage
    • A valid Grade 12 or Matric Equivalent Certificate
    • Knowledge of Medical Aid Policies & Procedures
    • Computer literacy essential
    • Above average interpersonal and Communication Skills
    • Absolute compliance with Confidentiality Policies and Procedures

     Duties and responsibilities will include, but is not limited to the following:

     Accountability and responsibility

     Case management 

    • Constantly monitoring patient status
    • Constantly liaising with Medical Aids updating patient status
    • Effective communication with Patients, Doctors, Nursing Staff, Medical Aids etc.
    • Ensure adequate record keeping.
    • General administration duties

    Maintaining standards

    • Ensure that the complete Case Management function is consistently performed on a daily basis.
    • Application of policies for the operation within the Hospital Industry

This is not a job description, but merely a guideline to facilitate application

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