A vacancy exists for a Field Case Manager (Specialised), Coast East Region, reporting to the Regional Financial Controller. The successful candidate will be responsible for managing the financial and clinical risks of the patient event by ensuring accurate coding, clinical updates and accounts submissions of patient hospitalization to achieve key strategic objectives.

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 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.
Complying with governance and risk management requirements by ensuring adherence to patient services policies and procedures
Ensuring compliance to service level agreements with internal and external stakeholders
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 services standards
Investigating and reporting published alerts incidents and agreeing upon appropriate action with internal and external stakeholders
Ensuring effective management of relationships with internal/external stakeholders by
Building and maintaining relationships with internal stakeholders
Providing and facilitating training regarding RSRT contracts
Providing feedback and information regarding concerns or issues raised by external stakeholders
Providing feedback on external stakeholders impacting on the efficiency and effectiveness of the case management process
Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings

Requirements

Diploma or degree in Nursing, Physiotherapy, Clinical Associates, Paramedics as Critical Care Assistants or Emergency Care Practitioners or any other qualification that covers Anatomy, Physiology, Pathophysiology and Microbiology as foundational courses.
Experience including proven leadership, change and people management
Atleast 2 years’ experience working in would be advantageous
Current registration with the relevant professional / regulatory body (South African Nursing Council)
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
Valid Driver’s License
Must be Willing to Travel

Competencies

Verbal & written communication and presentation
Drive & energy
Ethical behaviour
Building relationships
Customer responsiveness
Organisational awareness

Please send your resume/CV