PERSONAL DETAILS

TITLE:

Ms.

FULL NAMES AND SURNAME:

Denise Gunkel

Telephone

068*******

DRIVERS LICENSE:

Yes / With own car.

LANGUAGES

English, Afrikaans

EDUCATION

Enrolled Nurse

Netcare Training Academy

2008

Current Position: Case / Marketing Manager

Current Company: Circle Healthcare Rehabilitation Hospital

Start Date: 01.02.2018 – Current

Manager Isabel Cruz

Contact 082*******

Role: Daily hospital visits to market the facility and all

role players.

Meeting with doctors, unit managers, physio,

social workers and all involved in the transfer

process of patients from the acute to sub-acute

setting from private hospitals.

Presentations to doctors within provincial setting

for transfer of RAF patients.

Relationship building and maintenance.

Assessment of patients who are ready for

transfer to sub- acute.

Obtaining auth from medical aid for admission

of medical aid patients.

Facilitation of transfer of patient to facility from

acute setting.

Attending family meetings as arranged by social

worker, within first week of patient admission.

Weekly MDT meeting attendance -Team: Social

Worker, Nursing manager, Physiotherapist,

Occupational therapist, Speech therapist, Dietician.

Weekly case management reports (medical aid

patients) In conjunction with MDT reports.

Update of equipment needs for medical aid and

RAF patients, as per OT/Physio reports.

Monthly RAF case management updates in

conjunction with MDT reports.

Discharge planning in conjunction with social

Worker and family

Previous Company.

Netcare Mulbarton Hospital

Position: Case Manager

01.07.2013 - 31.01.2018

Reference: Annette Malan

011-*******

Duties: printing a ward round list, according to patients in progress.

Document printed off the in house system- SAP.

Updating of cases, upon collection of clinical information.

Length of stay, level of care,icd10 codes and CPT codes updated.

Updates sent using the in house system-SAP.

Updating surgical procedures to be done.

Radiology and Pathology reports forwarded to the fund.

Informing patients of limits, exclusions or protocols, regarding certain diagnosis as per policies.

Updating ICU/High Care level of care, as per company protocols .

Motivating level of care in line with clinical information, should disputes arise.

Updating high cost drugs. Motivation as per organisms cultured on pathology reports.

Interpretation of Radiology and Pathology results.

Liaising with all members of multidisciplinary healthcare team, to ensure accuracy of information, diagnosis and procedures.

Requesting authorization for transfer of patient to acute care facilities.

Relationship building with external clients. E.g. Step down and rehabilitation center case managers.

Ensuring length of stay in standard predictable cases are adhered to.

Keeping patient and doctor up to date regarding authorizations and protocols, as per the different medical schemes.

Close communication with credit controllers, regarding high risk cases.

Communicating fund requirements to members of multidisciplinary healthcare team.

Completion of Case Manager Skills Audit on an annual basis- Pass requirement- 90%

Reason for leaving: Skills training opportunity.

Previous Company Life Fourways Hospital

Position. Case Manager Specialized/ General

02.04.2011 – 30.06.2013

Reference Francisca Van Staden

Tel 011-***-****

Duties: printing a ward round list, according to patients in progress.

Document printed off the in house system- Impilo

Updating of cases, according to company policies, length of stay, level of care,icd10 codes and CPT codes.

Updates sent using the in house system, for patient who have authorization.

Email updates sent, for patients admitted without authorization.

Updating surgical procedures to be done, to ascertain prosthesis limits, exclusions or copayments.

Relevant documents required by the fund, for updating of surgical cases, requested from doctors rooms.

Informing patients of limits, exclusions or protocols, regarding certain diagnoses, from the fund (eg, only 2 days authorized for back pain, only 2 days cover for headache, without confirmed diagnosis, 24 hours cover for “R” codes.

Updating ICU/High Care level of care, as per company protocols. Motivating level of care, in line with clinical information, in cases where disputes arise, pertaining to loc.

Updating high cost antibiotics.

Liaising with the various pharmaceutical representatives, to obtain pathology results, for doctor to provide motivation to the funds, for some of the high cost drugs.

Obtaining and forwarding radiology and pathology results to the fund, as part of a comprehensive update.

ICD10 and CPT coding examinations – standards and pass mark set out as per WHO standards

Maintaining relationships with credit controllers and informing them regarding possible short/non payments on accounts.

Sending final updates, with updated diagnosis codes, on discharge of patients.

Releasing accounts to funders for payment.

Reason for leaving: Life changing event occurred.

Previous Company Resolution Health

Position Case Manager

03.01.2010- 31.03.2011

Reference Nancey Sweeney

Tel 083*******

Duties: Receiving clinical data for update, from hospitals.

Approving /declining updates, based on information received.

Updates approved, based on internal protocols.

Meeting with Medical advisor to discuss high cost cases- Long stay patients,within special care facilities in hospital (ICU/High care, High cost medication,

High cost surgical appliances used)

Meeting with medical advisor to discuss ex-gratia and special cases(scheme exclusions) Liasing with brokers/ clients regarding feedback on outcome of ex-gratia and scheme exclusion cases).

Drawing up communication, as per outcome of special cases, when required in writing. Returning photographs and sensitive documentation, required for motivation.

Working closely with brokers and client liaison consultants, regarding urgent cases to be discussed with medical advisor.

Relationship building within broker houses and hospitals.

Oncology case approvals, based on in-house protocols and standards

Reason for leaving: Company restructuring

Contact this candidate