• To manage all aspects of patients who are admitted under a Managed Care Organization and hospital nursing staff by ensuring that treatment provided meets the requirements of the Managed Care Organization, the Hospital standards and cost targets

Job Description

• Assess patient conditions and needs to develop appropriate care plans
• Interact with patients and medical aid schemes
• Resolve patient and medical aid scheme queries
• Update all information timeously and accurately
• CPT and ICD coding
• Obtain doctors letters, motivations, and justifications in all appropriate cases under managed care of where medical aids request them from their hospitals as part of their assessing process
• Monitor patient admissions and identify those who have limitations, restrictions, place by their managed care/ medical aid structures e.g. length of stay, cost restrictions, fixed fees, per diem and other limiting fees or drugs and/ or formularies
• Maintain a control system that ensures the systematic monitoring of managed care patients
• Handling patient queries
• Update hospital information

Job Requirements

• Qualified Registered Nurse
• A qualified EN with relevant experience would be considered
• Both need to registered with SANC and proof of indemnity cover
• Minimum 3 years nursing experience in a multidisciplinary hospital.
• Experience and exposure in Theatre and/or ICU would be advantageous
• Hospital or Medical Aid scheme case management would be an advantage.
• Experience in ICD 10 and CPT coding is essential
• Knowledge of Prescribed Minimum Benefits (PMB) Scheme rules and policies
• Excellent communication skills (written and spoken)
• Excellent analytical and problem-solving skills
• Excellent MS Office computer skills, i.e. Outlook, Word, Excel, Kronos, Clinic Manager, etc.
• Attention to detail
• Ability to cope well under pressure