Clinical Case Manager

Non-Negotiable Requirements:

• Registered Enrolled Nurse or Registered Nurse qualification.
• 2 years within a case management role.
• Minimum 3 years nursing experience in a hospital.
• Case Management experience and proficiency in ICD 10 and CPT 4 coding.
• Computer proficiency.

Key Performance Areas:

• Ensure daily authorisation of inpatient admissions.
• Confirm authorisation details and follow up on any outstanding requests.
• Perform daily ward rounds for patients at length of stay limits and submit clinical updates.
• Work with the Patient Administration Manager to ensure correct billing and LOC.
• Coordinate patient transfers and communicate authorisation details.
• Compile and submit reports, maintaining accurate records of funder communications.
• Attend meetings and ensure all patient accounts are authorised to avoid non-payment risks.
• Develop unit-specific SOPs and ensure compliance with relevant legislation.
• Report incidents and maintain relationships with funders for timely authorisation responses.