Case Manager -Khayelitsha District Hospital at Western Cape Department of Health and Wellness

REQUIREMENTS :

• Minimum educational qualification: Appropriate three-year health related National Diploma/ Degree registrable with the Health Professions Council of South Africa (HPCSA) or South African Nursing Council (SANC). Experience: Appropriate experience in the Managed Health Care sector i.e. Case Management or Medical Aid environment and Revenue Generation.
• Competencies (knowledge/skills): Knowledge of the Medical Schemes Act 131 of 1998, regulations and annexures as amended. Knowledge of prescribed minimum benefits i.e. the chronic disease list and diagnostic treatment pairs. Basic knowledge of the uniform patient fees schedule and patient billing. Knowledge of and experience in ICD 10 Codes assignment and the ability to link patient diagnosis with procedure codes. Knowledge of Clinicom and EDI (Electronic Data Interchange). Ability to work with Excel spread sheets, Microsoft Word and web based programs (medical aids). Excellent communication, conflict management, interpersonal and leadership skills. Excellent written and verbal communication in at least two of the three official languages of the western cape.

DUTIES :

• Perform Case Management functions, i.e. obtaining pre-authorization and verification of benefits as needed, concurrent, retrospective review, discharge planning and provide quotations to H2, H3 and foreign patients. Assist with Medikredit EDI rejection reports and ensure corrections are completed timeously and resubmitted to Medikredit. Liaise with the various role-players e.g. clinicians, managed care organizations and medical scheme case managers to monitor utilisation and update patient’s clinical information while in hospital. Manage and implement case management policies, protocols and procedures in the hospital. Conduct clinical audits of patient accounts inclusive of medical aids, state departments e.g. RAF and COIDA to ensure accuracy of invoices with regard to ICD 10 codes, UPFS procedure codes and resource utilization. Manage and supervise Case Management and Revenue departments.