Role Summary

The Case Manager utilizes clinical knowledge and expertise to mitigate financial risk through comprehensive, accurate coding of hospital events and justification of hospitalization, including level of care and length of stay. The incumbent liaises between patients, treating clinicians, and managed care organisations to provide an accurate clinical motivation/indication of the patient’s stay in hospital. The Case Manager also applies clinical knowledge in risk management of patients.

Key Work Output and Accountabilities

• Diagnostic and procedural coding: ensure appropriate, complete and relevant coding of all patient records.
• Application of clinical knowledge for effective ICD‑10 and CCSA coding of patient events.
• Clinical coding of all patient events with valid ICD‑10 and CCSA codes relevant to diagnosis, treatment, and procedures.
• Review clinical coding throughout patient stay.
• Risk mana...