Clinical Case Manager at Lenmed Private Hospitals

Main Focus Areas

• The Clinical Case Manager utilising clinical knowledge and expertise, mitigates financial risk through comprehensive and accurate coding of hospital events, and communication with funders on the justification for hospitalization level of care and length of stay.​

Key Performance Areas: (include but are not limited to)

• Responsible for the application of clinical knowledge in justifying patient hospitalization in terms of treatment, length of stay and level of care.​
• Monitor and action risks related to medical aid benefits and hospitalization.​
• Ensure accurate specific and comprehensive clinical coding.​
• Timeous, effective communication and follow-up with medical aids.​
• Review authorization aspects approved, mitigating financial risk and final releasing of the case for billing.​
• Liaise with a network of internal and external stakeholders regarding patient treatment.​
• Adhere to the NHN Managed Health Care rules engagement.​
• Compliance with all industry relevant legislative acts, regulations and circulars.​

Post Requirements: (include but are not limited to)

• B Degree/Diploma Nursing qualification and/or Case Management qualification will be an advantage.​
• Diverse clinical nursing experience.​
• Case Management experience.​
• ICD 10 / CPT coding qualification or experience.​
• SAP IS-H experience will be advantageous.​
• Proficiency in Microsoft Office products.​
• Continuous Lenmed Learn training.​