MAIN PURPOSE OF JOB

Effectively and efficiently manage the hospital case management process and facilitate the communication process between all role players by providing accurate and timeous clinical information to minimise the financial risk for the organisation

KEY RESPONSIBILITY AREAS

1. Effective coordination of patient care plans to minimise financial risk for the company
2. Effectively manage the quality of clinical documentation
3. Provide clinical expertise for managing insurance claims with the supportive medical justifications based on good clinical practice
4. Focus on continuous quality improvement of clinical documentation
5. Conduct concurrent and retrospective utilization reviews to ensure medical necessity, appropriate level of care, and compliance with payer requirements.
6. Monitor Length of Stay (LOS) and facilitate timely discharge planning.
7. Coordinate with treating physicians and ins...