Case Manager (Readvertised) – Medicare Private Hospital at Africa Health Care

Description

• An advert exists for a Case Manager, reporting to the Patient Administration Manager.
• The position’s primary responsibilities include efficient patient case management and the delivery of an efficient and professional service to the internal and external customers.
• The successful candidates will be goal oriented with strong customer, quality, and performance focus.

Critical Outputs

• Ensure that pre-admission and pre-authorization information is accurate and in accordance with hospital and funder procedures.
• Carry out clinical coding in accordance with CPT/CCSA and ICD requirements.
• Daily ward rounds for effective clinical update communication and timeous follow up with medical aids.
• Maintain patients’ clinical status in accordance with funder approval requirements for the duration of hospitalization; keeping patients informed and managing the entire hospital stays’ financial risk.
• Provide complete and accurate updates and discharge information of all accounts.
• Maintaining accurate accounts of all admissions
• Handle patient files in accordance with hospital procedures.
• Timeous electronic submission of accounts and follow-up on short payments arising from case management related issues.
• Ensure the adherence of hospital staff to funder rules and coding procedures.
• Keep well informed on legislation pertaining to funders and related Health Care matters.

Requirements

• Nursing: SANC registration RN or EN, with Case Management qualification/experience
• Nonclinical case managers with Case Management qualification/experience
• High school matric certificate.
• 3 – 5 years’ experience in clinical coding, private hospital case management and Medical Aid administration procedures.
• Knowledge of hospital billing, funder contracts and tariffs would be an advantage.
• Have sound computer literacy skills and working knowledge of MS office, word and excel.
• Excellent communication skills and the ability to form and build strong relationships & partnerships with internal & external stakeholders.
• Excellent negotiation skills & the ability to interact with tact and diplomacy.

Competencies

• Collaboration/ Relationship Building
• Problem-solving, analysis and judgement
• Resilience
• Engaging diversity
• Verbal & written communication and presentation skills
• Influencing
• Customer responsiveness
• Organisational awareness
• Excellence and quality orientation
• Ethical behaviour

 Closing: 2025-07-22