Case Manager

ABOUT

Intercare is a dynamic healthcare company focusing on offering value-based healthcare to patients. As ambassadors of the Intercare brand, everything we do is guided by our purpose to make people feel better. Our shared values of People-centred, Integrity, Inclusivity, Excellence and Innovation define what we believe and who we are.

Intercare SSISA Rehabilitation Hospital Pty Ltd situated in Newlands, Cape Town is recruiting for a Case Manager. The purpose of the position is to create awareness of services offered amongst key stakeholders in the area, to identify patients aligned with admission criteria and to coordinate and provide a professional and efficient Case and Risk Management function.

CRITICAL OUTPUTS

1. Participate in recruiting referring Doctors and other members of the professional team.
2. Build productive relationships with healthcare professionals to ensure adequate referral rates to achieve budgeted occupancy levels.
3. Conduct clinical assessments to ensure that transfers and admissions adhere to criteria.
4. Obtain authorisation from funders/medical aids & submit required documentation during the patient stay to ensure timeous payment of accounts.
5. Minimise the financial risk by effectively managing patients stay.
6. Coordinate feedback from the multi-disciplinary team and communication on multiple platforms.
7. Provide management, audit, progress and discharge reports.
8. Effectively manage and maintain patient outcomes data.
9. Ensure compliance to case management procedures, contracts and legal aspects by utilising available resources and systems.

REQUIREMENTS

1. Registered with SANC as a Registered Nurse
2. At least 3 years' Case Management experience in a Sub-Acute or Acute hospital environment
3. Previous experience in marketing services in a healthcare environment
4. Working knowledge of ICD & CPT coding would be advantageous
5. Working knowledge of Fund’s rules, limits & contracts; perdiem/fixed fee interpretation; tariffs an advantage
6. Manage daily workflow, case management and coding processes
7. Full computer literacy on all MS Office packages
8. B2B EMS (electronic messaging systems: check status of authorisation and used for problem solving)
9. Ability to build relationships with Health Care Professionals
10. Excellent Administrative & Negotiation skills required
11. Patient admin programmes on the AS400 system