Clinical Case Manager – RHHC (2 positions)
Lenmed · Kimberley
Job description
About the role
The Case Manager utilises clinical knowledge and expertise to mitigate financial risk through comprehensive and accurate coding of hospital events, and communicates with funders to justify the level of care and length of stay for hospitalised patients.
Key responsibilities
- Apply clinical knowledge to justify patient hospitalisation in terms of treatment, length of stay and level of care.
- Monitor and act on risk related to medical‑aid benefits and hospitalisation.
- Ensure accurate, specific and comprehensive clinical coding.
- Provide timely and effective communication and follow‑up with medical aids.
- Review authorisation aspects, mitigate financial risk and release cases for billing.
- Liaise with internal and external stakeholders regarding patient treatment.
- Adhere to NHN Managed Health Care rules of engagement.
- Comply with all relevant legislative acts, regulations and circulars.
Required profile
- B Degree/Diploma in Nursing and/or Case Management qualification.
- Diverse clinical nursing experience.
- Case Management experience.
- ICD‑10 / CPT coding qualification or experience.
- SAP IS‑H experience (advantageous).
- Proficiency in Microsoft Office products.
Required skills
- ICD‑10 coding
- CPT coding
- SAP IS‑H
- Microsoft Office
Questions fréquentes
Why are you reporting this job?
Explore further
Salaries, guides and searches in South Africa.
Salaries by job title
Apply in 30 seconds
Enter your email to apply. An account will be created automatically.
By continuing, you accept our terms of use.
Already have an account? Login
A question about this job?
Ask it here: you will get the full job summary by e-mail, right away.
Boost your chances
Upload your CV — we will match you with relevant openings.
Analyzing your CV...
Lenmed
Kimberley