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
- 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
- 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