This position reports to the Patient Administration Manager.
PURPOSE:
The Clinical Case Manager is responsible for ensuring that all treatment provided to patients is authorized by liaising with funders, patients, doctors, and clinical employees. This role ensures the proper coordination of patient care with the necessary authorizations, communication with funders, and adherence to financial clinical policies and procedures.
Key Performance Areas:
Case Management:
Ensure daily authorization of inpatient admissions.
- Confirm authorization details and follow up on any outstanding requests.
Perform daily ward rounds for patients at length of stay limits and submit clinical updates.
Customer Service:
Work with the Patient Administration Manager to ensure correct billing and LOC.
Coordinate patient transfers and communicate authorization details.
Administration:
Compile and submit reports, maintaining accurate records of funder communications.
Financial Control:
Attend meetings and ensure all patient accounts are authorized to avoid non-payment risks.
Policy, Procedure, and Legislation:
Develop unit-specific SOPs and ensure compliance with relevant legislation.
Quality Assurance:
Report incidents and maintain relationships with funders for timely authorization responses.
Requirements:
- Registered Enrolled Nurse or Registered Nurse qualification.
- Minimum 3 years' nursing experience in a hospital.
- Case Management experience and proficiency in ICD 10 and CPT 4 coding.
- Computer proficiency.
Desired Skills:
- case management
- Patient administration
- Patient transfers
- Reporting
- ICD10
About The Employer:
Established Private Hospital
