Pre-Admissions Clinical Assessor (4 Months Sessional) at Life Healthcare

Introduction

A vacancy exists for a Pre-Admissions Clinical Assessor, based at Life Wilgers Hospital, reporting to the Patient Service Manager.

The successful candidate will be responsible for the management of the financial and clinical administrative risks pertaining to future patient admissions.

Critical Outputs

Manage pre-admission risk

• Perform clinical assessments and document clinical history
• Ensure all pre-admissions are accurately clinically coded in accordance with the coding standards
• Efficient and proactive pre-admission of all patients in accordance with Group protocol and close liaison with Case Management and National Credit Risk Departments to minimize risk exposure to the Hospital.
• Ensure high standard of documentation and capture of relevant information for all admissions through hands-on supervision and training.
• Maintain a high level of customer focus amongst all staff at the Pre-Admission Clinic to the benefit of the Hospital, Public and Doctors.
• Optimal management of bed and theatre bookings through close liaison with ward and Doctor’s rooms
• Sound working knowledge and application of Funds relevant rules and limits.
• Manage authorisations requests and benefit confirmations i.e. prosthesis benefit confirmation  
• Monitor insurance verification with the funder 
• Monitor workflow processes 
• Identify and monitor gaps and risks and implement corrective actions accordingly. 

Ensure effective management of quality outputs 

• Adhere to ISO 9001 standards 
• Perform quality walkabouts and implement corrective measures, where appropriate 
• Implement and monitor quality improvement programmes through power teams 
• Adhere to patient services escalation processes 
• Monitor Q-evaluator score and implement corrective measures, where appropriate 
• Investigate internal and external stakeholder complaints and take appropriate action 
• Drive adherence to customer service standards

Ensure and promote operational excellence 

• Drive compliance to LHC policies regarding authorisations and deviations 
• Implement corrective actions, where necessary 
• Monitor reports 
• Monitor and adhere to patient service policies and procedures 
• Ensure compliance to service level agreements with internal and external stakeholders 

Ensure effective management of relationships with internal/external stakeholders 

• Foster and maintain healthy relationships with internal stakeholders 
• Provide relevant feedback and information on concerns or issues raised by internal stakeholders 
• Implement corrective actions on deviations directly impacting case management processes 
• Monitor and advise on effective and regular communication with external stakeholders 
• Manage escalated concerns from Case Managers with external stakeholders

Requirements

• Nursing Qualification, preferably Professional Nurse or Enrolled Nurse with at least three to five years of experience 
• Current SANC registration 
• Knowledge of hospital patient services and case management processes
• Knowledge and understanding of CPT & ICD coding
• Knowledge of Funder contracts, scheme rules, exclusions and benefits
• Understanding of private hospital industry and practices
• Computer proficiency

Competencies

• Problem-solving, analysis and judgement 
• Resilience
• Engaging diversity
• Verbal & written communication and presentation
• Influencing
• Drive & Energy
• Excellence orientation 
• Ethical behaviour
• Building relationships 
• Customer responsiveness 
• Organisational awareness
• Leading by example (Key for Managers)
• Motivating and developing people (Key for Managers)