Kimberley: Case Manager

Key Performance Areas: Responsible for application of clinical knowledge in justifying patient hospitalisation in terms of treatment, length of stay and level of care. Monitor and action risk related to medical aid benefits and hospitalisation. Ensure accurate, specific and comprehensive clinical coding Timeous, effective communication and follow up with medical aids. Review authorisation aspects approved, mitigating financial risk and final releasing the case for billing. Liaise with a network of internal and external stakeholders regarding patient treatment. Adhere to the NHN Managed Health Care rules of engagement. Compliance with all industry relevant legislative acts, regulations and circulars Post Requirements: B Degree/Diploma Nursing qualification and/or Case Management qualification Diverse clinical nursing experience Case Management experience ICD-10 / CPT Coding Qualification or Experience SAP IS-H experience advantageous Proficiency in Microsoft Office products