Mediclinic Morningside | Morningside, Johannesburg | South Africa
Closing date: 14/03/2025
Number of positions: 1
Recruiter name: Lesley Du Plessis
Reference number: 58437
Workplace Type: On-site
Employment Type: Permanent
Please note if you are an internal employee on a fixed term contract please apply using an external candidate profile and not your employee profile.
MAIN PURPOSE OF JOB
To coordinate the hospital case management process and facilitate the communication process between all role players by providing accurate and timely clinical information to minimize the financial risk for the organization.
KEY RESPONSIBILITY AREAS
1. Minimize financial risk by effectively managing patient stay.
2. Ensure compliance with case management procedures, contracts, and legal aspects by utilizing available resources and systems.
3. Ensure correct and timely finalization of cases to facilitate reimbursements from funders of claims.
4. Consistently and timely communicate with funders as contractually agreed through the relevant case management channels.
5. Ensure clinical coding standards are adhered to as per Level 3 coding guideline.
6. Lead and manage the people in the Case Management team (if applicable).
REQUIRED EDUCATION
DESIRED EDUCATION: Registered Nurse / Professional Nurse or qualified Paramedic.
REQUIRED EXPERIENCE
ESSENTIAL MINIMUM EXPERIENCE: Minimum of 3 years in a clinical role.
DESIRED EXPERIENCE: Experience in Theatre and/or ICU; Medical aid background; Experience in private healthcare environment or experience as an ILS/ALS Paramedic.
REQUIRED JOB SKILLS AND KNOWLEDGE
* Anatomy, physiology, and terminology.
* Funder Contracts; Medical aid requirements/narrations.
* Scientific nursing principles and process.
* B2B EMS (electronic message system: check status of authorizations and use for troubleshooting).
* Authorization and motivation of Level of Care; Length of Stay; Short Payments, etc.
* Relevant aspects of applicable statutory acts (e.g., Consumer Protection Act; PMB; etc.).
* Patient Administration policies and procedures (e.g., Patient Confidentiality; Visitation of external case managers; etc.).
* Daily workflow; managing deviations; coding; and case management processes.
* Application of clinical codes and finalization thereof (Level 3 coding).
* Patient admin programs on the AS400 system.
All applicants will be considered, with the understanding that preference will be given in accordance with the Employment Equity Plan of Mediclinic Southern Africa, as well as internal applicants/employees that meet the minimum requirements.
Please note if you are an internal employee on a fixed term contract please apply using an external candidate profile and not your employee profile.
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