Pre-Admission Clinical Evaluator
Function: Patient Services
Center: Life Mercantile Hospital
Position: Pre-Admission Clinical Evaluator
Introduction
There is a vacancy for a Pre-Admission Clinical Evaluator at Life Mercantile Hospital, who will report to Jacqueline Naude, Patient Services Manager. The selected candidate will be responsible for managing the administrative, financial, and clinical risks related to future patient admissions.
Key Results
Manage pre-admission risk:
Conduct clinical evaluations and document medical histories.
Ensure all pre-admissions are accurately coded clinically according to coding standards.
Perform efficient and proactive pre-admissions for all patients according to the Group protocol and maintain close collaboration with the Case Management and National Credit Risk Departments to minimize the Hospital’s risk exposure.
Ensure a high level of documentation and the collection of relevant information for all admissions through supervision and hands-on training.
Maintain a high level of customer service among all Pre-Admission Clinic staff, for the benefit of the hospital, the public, and physicians.
Optimally manage bed and operating room bookings through close coordination with inpatient wards and physician offices.
Demonstrate a solid understanding and application of relevant funding regulations and limits.
Manage authorization requests and benefit confirmations, such as benefit confirmations for prostheses.
Oversee insurance verification with the funding entity.
Monitor workflow processes.
Identify and monitor deficiencies and risks, and implement appropriate corrective actions.
Ensure effective management of quality outcomes.
Comply with ISO 9001.
Conduct quality inspections and implement corrective actions as needed.
Implement and oversee quality improvement programs through work teams.
Comply with patient service escalation processes.
Monitor the quality evaluator’s score and implement corrective actions as needed.
Investigate complaints from internal and external stakeholders and take appropriate action.
Drive adherence to customer service standards. Ensure and promote operational excellence.
Drive compliance with LHC policies regarding authorizations and deviations.
Implement corrective actions as needed.
Monitor reports.
Monitor and comply with patient care policies and procedures.
Ensure compliance with service level agreements with internal and external stakeholders.
When operationally necessary, assist the case management team in their roles and responsibilities.
Ensure effective management of relationships with internal and external stakeholders.
Foster and maintain positive relationships with internal stakeholders.
Provide relevant information and feedback on concerns or issues raised by internal stakeholders.
Implement corrective actions for deviations that directly affect case management processes.
Monitor and advise on effective and regular communication with external stakeholders.
Manage concerns escalated by case managers with external stakeholders.
Requirements
Degree or diploma in Nursing, Physiotherapy, Clinical Assistant, Intensive Care or Emergency Care Technician, or any other qualification that includes Anatomy, Physiology, Pathophysiology, and Microbiology as core subjects.
Current registration with the South African Nursing Council (SANC).
Knowledge of hospital patient services and case management processes.
Knowledge and understanding of CPT and ICD coding.
Knowledge of insurance contracts, plan rules, exclusions, and benefits.
Understanding of the private hospital sector and practices.
Proficiency in computer applications.
Competencies
Problem-solving, analytical, and sound judgment.
Resilience.
Promoting diversity.
Verbal and written communication and presentation skills.
Influence.
Motivation and energy.
Commitment to excellence.
Ethical behavior.
Relationship building.
Customer service.
Organizational awareness.
Leading by example (key for executives).
Motivation and staff development (key for managers).
Email: nangamso.mbijela@lifehealthcare.co.za
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