Case Manager at Western Cape Department of Health and Wellness

Experience:

• 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.

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).

Duties

• 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. Relief colleagues. Supervision of staff and liaison with relevant role players in matters relating to Case Management.