Posted on :
2 Nov, 2021
2 Nov, 2021
The Case Management Officer is responsible for ensuring the best possible health care outcome for the patient at the most cost effective rate.
Job Title: Case Management Officer
Location: Mbabane, Hhohho, Eswatini
Reference #: Ekuphileni Clinic
Contract Type: Permanent
Salary: Market Related
•Audit claims and quotations submitted to health insurers/fundersRespond telephonically to clinicians to answer questions or attain details relating to treatments
•Monitor and oversee billing processes and procedures for the clinic
•Health education regarding screening tests being performed
•Reporting of any anomalies detected.
•Obtain pre-authorizations from health insurers for the patient to access services at the clinic
•Educate patients, family members or caretakers on care techniques required to enhance the recovery of a patient.
•Assist patients with the interpretation of medical documents.
•Discuss patient’s treatment modality with physicians, surgeons, and healthcare team
•Ensure tests administered to patients are appropriate and necessary
•Schedule follow-up treatments for patients
•Monitor patient response and progress of treatment to recommend adjustments where necessary
•Monitor the quality of health care provided to patients to ensure they are up to acceptable standard
•Help patient’s access government health aid and community health organization/social service benefits
•Prepare and implement patient discharge plan that allows for continued treatment after hospital discharge
•Ensure patients have the necessary utilities and amenities required for complete convalescenceAdministration
•Liaise between the Clinic, clients and health insurers/funders.
•Ensure appropriate coding of billing invoices according to the International Classification of Diseases (ICD-11).
•Maintain records of client treatment and progress of recovery while ensuring confidentiality
•Keeping accurate patient statistics
•Develop, maintain, and oversee weekly/monthly reports
•Reporting of any anomalies or concerns.
•Oversee the coordination and integration of health and case management functions in order to achieve a common goal
•Establish good working relationship with physicians to ensure timely and effective patient recovery
•Assess a patient’s health insurance cover and work with the insurer and multiple providers to ensure the best care is delivered with the least financial burden
Key Performance Indicators
•Accurate patient billing
•Liaison with health care stakeholders
•Other health care workers
•Medical aid companies
•Diploma in General Nursing, or Bachelor of Nursing or Bachelor of Science (Majoring in Nursing) .
•Registered as a Professional Nurse with the Eswatini Nursing Council
•5 years experience in a General Hospital offering the entire spectrum of medical specialties
Application Deadline: 09/11/2021