Case Manager
Healthcare, Government, Public Service
Minimum Requirements
- Appropriate experience in Case Management/Medical Aid Environment. Appropriate experience in ICD 10 codes assigned. Appropriate experience in liaison with medical aid (funders) and managed care organisations with regards to MHC policies, protocols, optimal fund utilisation and updated clinical information.
- Knowledge of the Uniform Patient Fees Schedule, Hospital Information Systems and EDI (Electronic Data Interchange). Knowledge of Medical Aid Act 131 of 1998 and the application of Prescribed Minimum Benefit (PMB) legislation i.e. the Chronic Disease List (CDL) and the Diagnostic Treatment Pairs (DTP). Ability to work with MS Excel and Web-based Programmes (medical aids). Ability to link patient diagnosis with procedure codes. Good communication skills (verbal and written).
Responsibilities
- Conduct clinical audits of Medical Aids and State Department, eg.
- RAF and COIDA to ensure accuracy of invoices.
- Co-ordinate the workflow process between clinical and admin personnel supporting various role players within the hospital wrt ICD-10 codes, prescribed minimum benefits and account queries.
- Implement Case Management policies, protocols and procedures within the hospital.
- Perform hospital Case Management functions wrt authorisation, benefit management, and review of clinical information for externally funded clients.
- Provide quotations to privately funded and foreign patients and compile statistical reports.
- Relief colleagues.
- Supervision of staff and liaison with relevant role players in matters relating to Case Management.
