Case Manager

Case Manager

Job Description

  • Responsible for the case management process within the hospital.
  • Conduct ward rounds and ensure the accurate complete collection of clinic data from patient files and liaisons with nursing staff and attending clinicians.
  • Update accurate clinical information to justify, length of stay (LOS) and level of care (LOC) to medical funds the assigned managed care organization.
  • Update and provide the necessary information to funders regarding HV (high value) items, limited benefits and protocols as defined by managed care organizations.
  • Communicate funder requirements / responses to attending clinicians and patients where necessary, and ensure compliance with industry standards.
  • Ensure effective management of real time and manual messaging, including request, responses, rejections and submissions.
  • Ensure the accurate submission of accounts to funders.
  • Understand and ensure adherence to patient’s services policies and procedures.
  • Ensure accurate and complete coding of patient accounts.
  • Ensure the correct application and correct interpretation of funder contracts.
  • Ensure the correct application and correct interpretation of funder FFS claims.
  • Action and close off short payment queries associated with assigned responsibilities.
  • Interacts with medical schemes to ensure that authorisations are provided timeously.
  • Ensures accurate application and interpretation of specialised wards criteria.
  • Provides support for the management of alternative fee structures.
  • Maintains client service principles to ensure client expectations are met.


Company Profile:

Salary: Not disclosed

Industry: Medical / Healthcare / Hospital

Functional Area:

Role Category: Others

Employment Type: Full time

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