Case Manager (Clinical Coding) at Netcare Pelonomi Private Hospital
Netcare Group
Overview
Netcare is hiring a Case Manager for Pelonomi Private Hospital. You will use your clinical knowledge to manage patient hospitalisation, handle diagnostic and procedural coding (ICD 10 and CCSA), and work closely with doctors, patients, and medical schemes. This is a full time hospital based role ideal for a nurse with at least 3 years healthcare experience who is ready to specialise in managed care case management.
About the role
As a Case Manager at Netcare Pelonomi Private Hospital, you will play a vital role in bridging clinical care and financial risk management. Using your nursing background, you will ensure that every patient's hospital stay is accurately coded, justified, and managed in line with medical aid benefits.
Your day to day work will involve reviewing patient records, applying ICD 10 and CCSA codes, monitoring length of stay and level of care, and communicating clinical motivations to managed care organisations. You will also support discharge planning and help keep hospital billing accurate.
This role offers you the chance to grow within one of South Africa's leading private hospital groups, working alongside a multidisciplinary healthcare team.
Important application note: Netcare values care, truth, participation, compassion, and dignity. Your application should reflect these values. No specific documents or email instructions were provided in the listing, so apply through the PNet platform.Requirements
- B Degree or Diploma in Nursing (NQF level 6) or equivalent
- Enrolled Nursing qualification (NQF level 4) or equivalent
- Qualification in associated Healthcare Sciences or Managed Care/Case Management
- Minimum 3 years professional healthcare experience
- Intensive Care Nursing experience is beneficial
- Previous hospital and medical scheme case management experience is beneficial
- General administrative skills
- Computer literate
- ICD 10 and CCSA coding experience or qualification
- Knowledge of nursing and pharmacy policies and procedures
- Willingness to work overtime when required
Responsibilities
- Ensure appropriate, complete and relevant diagnostic and procedural coding of all patient records
- Apply clinical knowledge for effective ICD 10 and CCSA coding of patient events
- Review clinical coding during patient stay in hospital
- Apply clinical knowledge in risk management of patients regarding length of stay, level of care and medical aid benefits
- Monitor and action risk related to medical aid benefits and hospitalisation
- Provide clinical data to substantiate length of stay and level of care
- Accompany Managed Care Organisation Case Managers on ward rounds when required
- Release patient accounts for billing relating to coding, length of stay and level of care
- Conduct daily clinical rounds to all patients for assessment and evaluation
- Send electronic clinical updates to managed care organisations and insurance providers
- Final authorisation and releasing of discharged patient accounts after reviewing authorisation, length of stay, level of care and coding
- Monitor patients in progress reports and ensure ward movements, bed status and level of care on the system is accurate
- Facilitate discharge planning and movement of patients to step down or rehab facilities
- Assist with case management queries and investigations from funders, doctors and patients
- Participate in transition of care projects as per policy
- Review and action emails
- Capture risk factors
- Maintain patient confidentiality
- Manage associated administrative tasks
- Comply with all industry relevant legislative acts, regulations and circulars
Job details
- Organisation
- Netcare Group
- Job type
- Full time
- Experience level
- Mid (3+ years)
- Education
- Diploma
- Category
- Healthcare & Nursing
- Application Method
- Apply online
Success Guide
Hi there. If you are a nurse with a few years of experience under your belt and you are curious about the business side of healthcare, this Case Manager role at Netcare Pelonomi could be a great next step for you.
Case management is all about balancing patient care with medical aid rules. In your interview, expect questions about how you would handle a patient whose benefits are running out, or how you would motivate for a longer hospital stay. Brush up on ICD 10 coding basics if you have not used them recently.
Make sure your CV clearly shows your nursing qualification, your years of clinical experience, and any exposure to medical schemes or coding. If you have ICU experience, highlight it. Netcare takes their values seriously, so be ready to talk about care, truth, dignity, compassion and participation. Good luck, you have got this.
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