Nursing Case Manager (Hospital Group) – Cape Town, Western Cape 26 views
Job Overview
Requirements:
- Qualified Registered Nurse
- A qualified EN with relevant experience would be considered
- Both need to registered with SANC and proof of indemnity cover
- Minimum 3 years nursing experience would in a multidisciplinary hospital
- Experience and exposure in Theatre and/or ICU would be advantageous
- Hospital or medical aid scheme case management would be an advantage
- Experience in ICD 10 CPT coding is essential
- Knowledge of prescribed minimum benefits (PMB) scheme rules and policies
- Excellent communication skills (Written and spoken)
- Excellent analytical and problem-solving skills
- Excellent MS office computer skills, i.e. Outlook, Word, Excel, Clinic Manager, etc.
- Attention to detail
- Ability to cope well under pressure
Duties & Responsibilities:
- Assess patient conditions and needs to develop appropriate care plans
- Interact with patients and medical aid schemes
- Resolve patient and medical aid scheme queries
- Update all information timeously and accurately
- CPT and ICD coding
- Obtain doctors letters, motivations, and justifications in all appropriate cases under managed care of where medical aids request them from their hospitals as part of assessing process
- Monitor patient admissions and identify those who have limitations, restrictions, place by their managed care/ medical aid structures e.g. length of stay, cost restrictions, fixed fees, per diem and other limiting fees or drugs and/or formularies
- Maintain a control system that ensures the systematic monitoring of managed care patients
- Handling of patient queries
- Update hospital information
