About Life Healthcare

Life Healthcare is a global, diversified people-centred and Johannesburg Stock Exchange-listed healthcare organisation that in southern Africa offers acute care, acute mental health, acute rehabilitation and renal dialysis services. With 38 years of expertise and 66 world-class healthcare facilities across southern Africa, Life Healthcare provides acute care to over 600 000 patients every year.

Job Description

A vacancy exists for a Case Manager General Ward based at Life Cosmos Hospital, Mpumalanga, reporting to Anrita Engelbrecht, Patient Services Manager. The successful candidate will be responsible for managing the financial and clinical risks of the patient in a general ward by ensuring accurate coding, clinical updates and accounts submissions of patient hospitalization to achieve strategic objectives.

Critical Outputs

Ensuring the maximisation of revenue by

• Ensuring accuracy of coding
• Ensuring the correct application and interpretation of RSRT’s
• Participating in meetings and reporting losses to RSRT team and recommend corrective actions
• Monitoring insurance verification and workflow processes

Ensuring effective management of quality outputs by

• Performing quality walkabouts and implement corrective measures
• Implementing and monitoring quality improvement programmes
• Adhering to patient services escalation processes in order to achieve QMS targets
• Monitoring Q-evaluator scores and implementing corrective measures
• Investigating internal and external stakeholder complaints
• Ensuring the adherence to customer service standards

Ensuring operational excellence by

• Monitoring submission of accurate accounts to funders
• Updating length of stay and level of care to funders of general ward cases and where operationally required specialised unit cases.
• Releasing care risk targets and submission within two days of discharge
• Ensuring the compliance to LHC policies and managing authorisations and claim submissions, rejections and delays
• Ensuring governance and risk management by monitoring and adhering to patient services policies and procedures
• Ensuring compliance to service level agreements with internal and external stakeholders
• Ensuring all billing checks are closed by the relevant function areas

Ensuring effective management of relationships with internal/external stakeholders by

• Building and maintaining relationships with internal stakeholders
• Providing feedback and information on concerns or issues raised by internal stakeholders
• Providing and facilitating training regarding RSRT contracts to the relevant internal stakeholders
• Ensuring effective communication with external stakeholders
• Managing escalated concerns from Case Managers with external stakeholders
• Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings

Requirements

• Diploma or degree in Nursing, Physiotherapy, Clinical Associates, Paramedics as Critical Care Assistants or Emergency Care Practitioners or any other qualification that covers Anatomy, Physiology, Pathophysiology and Microbiology as foundational courses.
• 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

• Attention to detail
• Problem-solving, analysis and judgement
• Resilience
• Engaging diversity
• Verbal & written communication skills
• Professional and technical proficiency
• Building relationships
• Customer responsiveness
• Organisational awareness
• Influencing skills
• Action orientation
• Excellence orientation
• Ethical behaviour