Mediclinic is a diversified international private hospital group that was established in South Africa in 1983. The group provides specialist-oriented, multi-disciplinary healthcare services and has operations in Southern Africa (South Africa and Namibia), Switzerland, and the Middle East.

MAIN PURPOSE OF JOB

• To coordinate the hospital case management process and facilitate the communication process between all role players by providing accurate and timeous clinical information to minimise the financial risk for the organisation

KEY RESPONSIBILITY AREAS

• Minimise financial risk by effectively managing patient stay
• Ensure compliance to case management procedures, contracts and legal aspects by utilising available resources and systems
• Ensure correct and timeous finalisation of cases to facilitate reimbursements from funders of claims
• Consistently and timeously communicate with Funders as contractually agreed through the relevant case management channels
• Ensure clinical coding standards are adhered to as per Level 3 coding guideline
• Lead and manage the people in the Case Management team (if applicable)

REQUIRED EDUCATION

• ESSENTIAL EDUCATION:  Clinical qualification
• DESIRED EDUCATION:  Registered Nurse / Professional Nurse or qualified Paramedic

REQUIRED EXPERIENCE

• ESSENTIAL MINIMUM EXPERIENCE: Minimum of 3 years in a clinical role
• DESIRED EXPERIENCE: Experience in bedside nursing; Medical aid background; Experience in private healthcare environment or experience as an ILS/ALS Paramedic

REQUIRED JOB SKILLS AND KNOWLEDGE

• Understanding of anatomy; physiology and medical terminology
• Funder Contracts; Medical aid requirements/narrations
• Scientific nursing principles and process
• Authorisation and motivation of Level of Care; Length of Stay; Clinical Coding, high-cost stock, Short Payments etc.
• Use of electronic systems (i.e. B2B or Funder portals) for the purposes of requesting authorisations, performing case management updates and for troubleshooting)
• Computer literacy (Microsoft Office, hospital/practice management systems)
• Relevant aspects of applicable statutory acts (e.g. Consumer Protection Act; PMB; etc.)
• Patient Administration policies and procedures (e.g. Patient Confidentiality; Visitation of external case managers; etc.)