Case Manager

JOB SUMMARY





To plan, coordinate and execute case management work at hospital level. The incumbent utilises clinical knowledge to minimise financial risk and ensure accurate billing through comprehensive accurate coding of patient care.





REQUIREMENTS



Minimum Requirements:





Diploma in General Nursing.





Minimum Experience:





3-5 years' experience as a hospital case manager

Knowledge of private health care operations





Added Advantage:





Advance Certification in Intermediate coding

Degree: Nursing





Key Competencies:





Computer literacy

IDC and CPT coding

Coding standards and protocols

Understanding of diagnostic related groupers





DELIVERABLES





To Liaise with Receptionist for authorisations

Ensure compliance to case management procedures, standards and protocols

Plan, coordinate and execute Clinical coding in accordance with relevant CHG standards and protocols

Ensure accurate, appropriate and complete diagnostic and procedural coding of all patient records in the hospital

Timeously and consistently communicate and follow up with Funders (Medical Aids, COID, Government, RAF, DOL, etc.)

Provide appropriate clinical information to Funders in order to update Length of Stay, Level of Care, formulary utilisation, assistive devices / Prosthesis, diagnostic interventions, therapy intervention and procedural interventions and required change in the facility.

Consult daily with all relevant health care providers with regards to patient treatment

Ensure the maintenance of patients' clinical status (subsequent interventions and treatments) in accordance to Funder requirements for the duration of hospitalisation

Ensure the correct categorisation and management of different patient accounts to facilitate reimbursement by Funders

Ensure accurate and timeous finalisation of cases to facilitate reimbursement by Funders

Minimise financial risk by the effective management of patient hospitalisation

Follow the established and approved escalation processes in the event of a decline of payment by Funders

Ensure to remain in the group and facility targets of 3 days for WIP (work in progress) and DNYB (discharged not yet billed)





Closing Date 29 September 2026