A vacancy exists for a Case Manager - Specialised Units, based at Life Cosmos Hospital, reporting to Anrita Engelbrecht, Patient Services Manager.

The successful candidate will be responsible for the management of the financial and clinical administrative risks pertaining to patients in specialised units – intensive care units, high care units and neonatal intensive care units.

Critical Outputs
Ensuring operational excellence by:

Conducting ward rounds and ensuring the accurate complete collection of clinic data from patient files and liaisons with nursing staff and attending clinicians
Updating accurate clinical information to justify the length of stay and level of care to medical funds of specialised unit cases and where operationally required general ward cases
Updating and providing the necessary information to funders regarding high-value items, limited benefits, and protocols as defined by managed care organizations
Communicating funder requirements/responses to attending clinicians and patients where necessary, and ensuring compliance with industry standards
Ensuring effective management of real-time and manual messaging, including requests, responses, rejections, and submissions
Ensuring the accurate submission of accounts to funders

Ensuring effective management of revenue by:

Ensuring the accurate and complete coding of patient accounts
Ensuring the correct application and correct interpretation of funder RSRT contracts and FFS claims
Reporting RSRT risks identified to the relevant manager
Ensuring effective management of quality outputs by:

Adhering to patient services escalation processes and customer service standards
Investigating and reporting published alerts incidents and agreeing upon appropriate action with internal and external stakeholders

Requirements

Nursing qualification, Registered Nurse with at least five years of experience on which at least 2 should be in a specialised unit
Experience including proven leadership, change, and people management
Current registration with the relevant professional/regulatory body
Understanding of clinical coding, clinical terminology and anatomy, funder rules, co-payments and exclusions
Working knowledge of COID
Understanding of business and change management principles
Computer proficiency

Competencies

Problem-solving, analysis and judgments
Resilience
Engaging diversity
Verbal & written communication and presentation
Influencing
Drive & energy
Excellence orientation
Ethical behaviour
Building relationships
Customer responsiveness