Are you an experienced nursing professional with a passion for case management? Shelly Beach Hospital is seeking a **Case Manager** to facilitate seamless communication between patients, clinicians, and medical aid providers. If you have strong analytical skills, a solid understanding of **ICD-10 and CPT coding**, and experience in **private hospital billing**, this could be the perfect opportunity for you!
## **Why Join Shelly Beach Hospital?**
Shelly Beach Hospital is known for providing **quality care with compassion**. As a Case Manager, you’ll play a critical role in ensuring **accurate billing, effective communication, and smooth patient transitions** while working with a network of healthcare professionals.
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## **Key Responsibilities**
### **1. Hospital Billing & Account Management**
- Ensure all relevant **hospital billing details** are accurate and correctly recorded in the system.
- Assist **clinicians, patients, and medical aid providers** with account-related queries.
- Ensure compliance with **hospital policies, governance, and risk management requirements**.
- Monitor and control costs for **Managed Care Organization** patients.
- Confirm **length of stay** for all funders and assist with **final authorization** of patient files.
### **2. Case Management & Patient Coordination**
- Provide real-time **clinical updates**, including **requests, responses, rejections, and submissions**.
- Ensure effective communication regarding **funder requirements** with clinicians and patients.
- Assist with the **transfer of patients** to rehabilitation hospitals or step-down facilities.
- Consult with **relevant service providers** regarding patient care and treatment.
- Liaise with internal and external stakeholders to ensure **seamless patient management**.
### **3. Coding & Compliance**
- Ensure **accurate medical coding** for **Managed Care Organization** patients.
- Stay updated with **ICD-10 and CPT coding** guidelines.
- Maintain **compliance with medical aid billing standards**.
- Keep up to date with **hospital policies and evolving healthcare regulations**.
### **4. Performance & Professional Development**
- Meet monthly **cash collection targets** and maintain **ONVB days** at **5 or below**.
- Stay informed about **industry best practices** and **develop professional skills**.
- Work effectively under pressure while maintaining **professionalism and hospital standards**.
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## **Required Skills & Competencies**
- Strong **organizational awareness** and ability to build **good relationships** with service providers.
- Excellent **problem-solving** and **analytical skills**.
- Knowledge of **private hospital business operations** and **case management processes**.
- Proficiency in **ICD-10 and CPT coding**.
- Sound understanding of **billing, tariffs, and funder guidelines**.
- Ability to **clearly communicate information** in both written and verbal formats.
- Strong **interpersonal skills** and the ability to **work well under pressure**.
- High attention to detail, with the ability to **prioritize tasks effectively**.
- Knowledge of **clinical coding, funder rules, and advanced coding experience**.
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## **Minimum Requirements**
- A relevant **nursing qualification** that allows registration with the **South African Nursing Council (SANC)** as a **Registered Nurse or Enrolled Nurse**.
- **Proof of registration** with **SANC**.
- **At least 2-3 years of Case Management experience**.
- **Computer proficiency** is essential.
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## **How to Apply**
If you meet the above requirements and are interested in this position, please submit the following documents:
✅ **Updated Curriculum Vitae (CV)**
✅ **Certified copies of qualifications**
✅ **Certified copy of your ID**
### 📧 **Send your application to:** [vacancies@shellybeachhospital.com](mailto:vacancies@shellybeachhospital.com)
### **🗓 Closing Date: 14th March 2025 at 16:00**
⚠️ **No late applications will be considered.**
📞 **Contact us:** 087 087 6115
🌐 **Visit our website:** [www.shellybeachhospital.com](http://www.shellybeachhospital.com)
📍 **Location:** Lot 2489 Flamingo Road, Shelly Beach, 4242
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### **Why This Job is Perfect for You**
This role is ideal for **healthcare professionals** with experience in **hospital case management**, **billing**, and **medical coding**. If you're looking for an opportunity to **apply your expertise in a reputable healthcare facility**, Shelly Beach Hospital offers the perfect environment to **grow your career** while making a meaningful impact on patient care.
**Apply today and take the next step in your case management career!**
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