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Case Manager
Melomed Private Hospitals SA
Western Cape
Full-time
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Job details

Pay information not provided
Full-time
Western Cape

Full job description

  • Assess patient conditions and needs to develop appropriate care plans
  • Interact with patients and medical aid schemes
  • Resolve patient and medical aid scheme queries
  • Update all information timeously and accurately
  • CPT and ICD coding
  • Obtain doctors letters, motivations, and justifications in all appropriate cases under managed care of where medical aids request them from their hospitals as part of their assessing process
  • Monitor patient admissions and identify those who have limitations, restrictions, place by their managed care/ medical aid structures e.g. length of stay, cost restrictions, fixed fees, per diem and other limiting fees or drugs and/ or formularies
  • Maintain a control system that ensures the systematic monitoring of managed care patients
  • Handling patient queries
  • Update hospital information

  • Qualified Registered Nurse
  • Minimum 3 years nursing experience in a multidisciplinary hospital.
  • Experience and exposure in Theatre and/or ICU would be advantageous
  • Hospital or Medical Aid scheme case management would be an advantage.
  • Experience in ICD 10 and CPT coding is essential
  • Knowledge of Prescribed Minimum Benefits (PMB) Scheme rules and policies
  • Excellent communication skills (written and spoken)
  • Excellent analytical and problem-solving skills
  • Excellent MS Office computer skills, i.e. Outlook, Word, Excel, Kronos, Clinic Manager, etc.
  • Attention to detail
  • Ability to cope well under pressure

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